Pre-Existing Conditions Exclusion Clause Samples
A Pre-Existing Conditions Exclusion is a contractual provision that denies coverage or benefits for medical conditions that existed before the start of an insurance policy. In practice, this clause typically applies to health or disability insurance, where the insurer will not pay for treatment, medication, or claims related to illnesses or injuries that were diagnosed or treated prior to the policy’s effective date. Its core function is to protect insurers from covering high-risk individuals for conditions that are already known, thereby managing risk and helping to keep premiums affordable for all policyholders.
Pre-Existing Conditions Exclusion. No Critical Illness benefit shall be payable if twenty-four (24) months immediately prior to the Insured Employees effective date the Insured Employee was attended to or received medical treatment, consultation, care or services by a Physician, including diagnostic measure for any symptom or medical problem which leads to a Diagnosis of or treatment for a Critical Illness condition unless the Diagnosis of the Critical Illness condition occurs later than twenty-four (24) consecutive months from the Insured Employees effective date or date of most recent Reinstatement of coverage under this policy.
Pre-Existing Conditions Exclusion. No Critical Illness benefit shall be payable if, twenty-four (24) months immediately prior to the Effective Date of Individual Insurance, the Insured Employee was attended to or received medical treatment, consultation, care or services by a Physician, including diagnostic measure for any symptom or medical problem which leads to a Diagnosis of or treatment for a Critical Illness condition unless the Diagnosis of the Critical Illness condition occurs later than twenty-four (24) consecutive months from the Effective Date of Individual Insurance or date of most recent Reinstatement of coverage under this policy. If this policy directly replaces one with another Insurer providing similar benefits, an Insured Employee who has satisfied the time period of pre-existing conditions limitation in a prior policy will be deemed to have satisfied the time period in this policy, but only to the extent of the Benefit Amount and Critical Illnesses covered in the prior policy. Any additional Benefit Amount provided in this policy will be subject to the terms of this exclusion. The prior policy must be cancelled within thirty-one (31) days prior to the date this policy came into force. An Insured Employee who has not satisfied the time period of pre-existing conditions limitation in a prior policy will be allowed to apply any amount of time satisfied under the pre-existing conditions limitation of the prior policy toward the satisfaction of the time period requirement of this Pre-existing Conditions Exclusion, but only to the extent of the Benefit Amount and Critical Illnesses covered in the prior policy. Any additional Benefit Amount provided in this policy will be subject to the terms of this exclusion. The prior policy must be cancelled within thirty-one (31) days prior to the date this policy came into force.
Pre-Existing Conditions Exclusion. For purposes of administering the Pre-existing Condition Exclusion in the regular Supplemental Disability plan as well as in the Supplemental Disability Continuation Rider, the period of continued coverage under the Supplemental Disability Continuation Rider will be considered a continuation of the regular period of coverage rather than a new separate time period.