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Question What is a pre-existing condition and can it be excluded from my health coverage?

Answer A pre-existing condition is any condition for which a person received treatment or treatment was recommended within the preceding six months. Any individual enrolling in a new health plan covered by NYS law may be subject to up to a 12 month waiting period (six months for Medicare Supplement policy holders) before expenses related to the pre-existing condition are covered. However, the plan must subtract from the waiting period the time that the person had continuous coverage in a previous plan. Continuous coverage means that the person had less than a sixty three day gap between coverages. The insurer shall count a period of creditable coverage for all benefits or may elect to credit coverage based on Catagories of Benefits specified in the policy or certificate.

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Health Insurance Resource Center

Comprehensive health insurance information for consumers
Contact: Department of Financial Services Consumer Assistance Unit
Phone: (800) 342-3736

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