Loader Icon
live aman bg

What is Pre-Existing Condition in Health Insurance

What is Pre-Existing Condition in Health Insurance

Credit [Photo by National Cancer Institute on Unsplash ]

  • Updated on 15 Aug 2023
  • Redaksi Liveaman
  • 3 Mins

Pre-existing condition in health insurance refers to a health condition that exists before an individual purchases an insurance policy. PEC can include various types of medical conditions, including chronic illnesses, congenital disabilities, or other health issues. In some cases, PEC can result in claim denials or increased insurance premiums.

To address the uncertainties and risks associated with PEC, many insurance companies implement pre-determined lists of PEC. These lists include various medical conditions that will not be covered by insurance policies or will only be covered after a specified waiting period.

Also read Data Privacy and Security in the Health and Insurance Industry

What is PEC? 

Pre-existing condition (PEC) refers to a health condition that exists before an individual purchases a health insurance policy. For example, if someone has been diagnosed with diabetes before purchasing a health insurance policy, diabetes would be considered a pre-existing condition. It is important to understand PEC and its implications in health insurance, as it can significantly impact insurance coverage and filed claims.

Risks of Providing False Information about Pre-Existing Condition

 When filing an insurance claim, it is crucial for policyholders to provide accurate information about their pre-existing conditions. Providing false information about PEC can lead to claim denials, policy cancellations, or even legal actions for insurance fraud. Therefore, it is important to always be honest and transparent when providing information about PEC to insurance companies. If there is a discrepancy between the information provided and the existing medical records, the insurance company may conduct further investigations to verify the accuracy of the information.

Requirements for Pre-Existing Conditions to be Covered

Some health insurance companies offer policies that cover PEC, but there are requirements that must be met before those benefits can be received. For instance, an insurance company may impose a waiting period before PEC is covered, which means the policyholder must wait for a certain period of time after purchasing the policy before being able to file claims related to PEC. Additionally, insurance premiums for PEC may be higher compared to premiums for other health conditions. This is due to the higher risks associated with PEC.

List of Insurance Covering PEC

Many health insurance companies offer policies that cover PEC, but it is important to note that the coverage and terms may vary between companies. It is crucial to carefully read the terms and conditions of the insurance policy to understand whether specific PEC is covered or not. Contacting the insurance company and requesting further information about PEC coverage is also a wise step. Some insurance companies may offer specific exclusions for certain PEC or provide special riders that cover PEC.

Causes of Insurance Denials 

There are several reasons why insurance companies may reject a health insurance application. One common reason is the presence of significant pre-existing conditions. Insurance companies may perceive PEC as too high of a risk or too expensive to cover. Additionally, if an applicant has provided inaccurate information or concealed their pre-existing conditions, the insurance company may reject the application. Insurance denial policies can vary between companies; therefore, it is important to find out the requirements and acceptance policies before submitting an insurance application.

Reasons for Having Insurance

Having health insurance can provide financial protection against unexpected health risks, including pre-existing conditions. By having insurance that covers PEC, policyholders can reduce the financial burden that arises from necessary medical treatments and care. Moreover, having insurance provides peace of mind and a sense of security, as policyholders know that they have financial protection in case of emergencies or serious illnesses.

Is ‘Existing’ the Same as ‘Pre-Existing’? 

Although the words “existing” and “pre-existing” sound similar, there are important differences in the context of health insurance. “Existing” refers to current health conditions, while “pre-existing” refers to health conditions that exist before purchasing an insurance policy. In the context of health insurance, special attention is given to PEC, which are the health conditions that exist before the policy purchase. PEC often has implications for insurance premiums, coverage, and specific exclusions imposed by insurance companies.

In conclusion, pre-existing condition (PEC) is a health condition that exists before an individual purchases a health insurance policy. PEC can affect coverage, premiums, and exclusions in insurance policies. It is important for policyholders to provide accurate information about their PEC and understand the terms and conditions of the insurance policy. Having health insurance that covers PEC can provide financial protection and peace of mind in facing health risks.

Also read Insurance Policyholder : Understanding Insurance and It’s Policy

Aman is a digital platform for employee benefits, where you can choose, buy, and manage health insurance in the form of benefits registration, claims monitoring, and analytical reporting.

There are various examples of health insurance and Aman service products that you can use, for example AmanCheck, to anticipate the prevention of various disease and diagnostic risks.

Get more complete information by visiting the help page on our website or consult directly via WhatsApp.

Come on, take care of your health and your family together with Aman!

Contact Us
Your Name*
Phone Number*
Work Email* (Please don’t use public email such as gmail, yahoo, hotmail, etc)
Company Name*
Confirmation email has been sent. Please wait our respond within 24 hours.
We have send the OTP to your email. Please verify.
Edit work email
Mohon masukkan kode verifikasi (OTP) disini*
Didn’t receive the verification code?120
We have send the OTP to your email. Please verify.
Please enter the correct OTP