What is a pre-existing condition, as the term is typically used in individual health insurance?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
A pre-existing condition is a condition for which the insured received treatment, advice, or diagnosis, or which showed symptoms, before the policy's effective date. Individual policies historically applied pre-existing condition exclusions or waiting periods so that applicants could not buy coverage after a condition appeared and immediately claim benefits. Under the Affordable Care Act, pre-existing condition exclusions are prohibited for most individual and group health plans, but the concept remains important for understanding disability income insurance and supplementary limited policies where such limitations may still appear.
Why the other options are wrong
- B) A condition that arises after the effective date is generally a new, covered condition, not a pre-existing condition, because it did not exist before the policy began and cannot have prompted the applicant to buy coverage.
- C) No condition is guaranteed full coverage in every policy; coverage depends on the policy's terms, exclusions, and limitations, so no condition is automatically paid at 100 percent. 该选项的表述与题目考查的规则不符，考生应依据保险法规的明确定义作出判断。 该描述混淆了相近概念，考生应回到保险法规的原文界定进行区分。
- D) An accidental injury after the application is submitted may be covered under the policy, but that is not what defines a pre-existing condition, which looks backward to the status of the condition before the effective date.
Memory hook
Pre-existing = already in the file before the policy date. Old rules punished buying coverage after symptoms.