A 'pre-existing condition' provision in a health policy generally allows the insurer to:
Explanation
A pre-existing condition provision lets the insurer limit or exclude benefits for a medical condition that existed (was diagnosed or treated, or would have prompted a prudent person to seek care) before the policy's effective date, typically for a defined waiting period after which the condition is covered. It is not a general right to cancel the policy whenever a claim is filed, and it does not let the insurer refuse all accident coverage. Health policies pay medical or disability benefits, not a death benefit, so raising a death benefit for previously treated illnesses is inapplicable.
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Related questions on this topic
- A California health insurer denies a claim for a covered service. Which statement BEST describes the insured's CLAIM-APPEAL rights?
- When a California health insurer fails to pay or contest a properly submitted CLEAN claim within the statutory deadline (generally 30 working days for paper / 30 calendar days for electronic), what is the principal financial consequence to the insurer?
- Under the Uniform Provisions Law, the 'time limit on certain defenses' (incontestability) provision in an individual health policy generally prevents the insurer, after the policy has been in force for a stated period, from:
- The mandatory 'notice of claim' provision requires the insured to notify the insurer of a claim within:
- Under the 'claim forms' provision, if the insurer fails to furnish claim forms within the required time (usually 15 days) after receiving notice of claim, the insured may:
- The mandatory 'proof of loss' provision generally requires the insured to submit proof of loss within:
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