Pre-existing Medical Condition Law and Legal Definition

Pre existing condition is a medical condition or healthcare problem that existed before enrolling in a healthcare plan. Most states implement the prudent standard for pre existing condition. According to the prudent standard test, pre existent condition can include any condition for which symptoms were present although medical advice, care, diagnosis or treatment may not have been received prior to enrollment. Under the "prudent standard," an "ordinarily prudent" individual would have sought medical advice, care, diagnosis, or treatment for any symptoms that were present prior to enrollment. States have specific laws on the subject and they often prescribe conditions which may and may not be included under pre existing medical condition.

Most health insurance policies restrict or exclude coverage for pre-existing medical conditions. Common examples of pre-existing medical conditions are pregnancy and diabetes.