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Pre-Existing Condition

A pre-existing condition is any medical issue, illness, or symptom that existed before your insurance coverage began, regardless of whether it was formally diagnosed. Insurers use this definition to assess risk and determine eligibility for certain benefits, particularly in medically underwritten or travel plans.

In health and dental coverage, pre-existing conditions may affect acceptance or limit coverage for specific treatments. In travel insurance, a pre-existing condition clause defines whether recent changes in medication or symptoms are stable enough to qualify for emergency medical protection. Some guaranteed acceptance plans still cover pre-existing conditions but with lower limits.

Example:

If you were treated for asthma before applying for a medically underwritten plan, your insurer may review that condition when determining eligibility or pricing.

What to Watch For:

Always answer health questions accurately on applications. For travel coverage, confirm stability requirements to ensure pre-existing conditions are protected during your trip.

Related Terms

Paramedical Disciplines

Paramedical disciplines refer to regulated health professionals who provide therapy or rehabilitation services outside of hospital settings. Common examples include physiotherapists, chiropractors, massage therapists, acupuncturists, naturopaths, osteopaths, psychologists, and speech-language pathologists.

Pay-Direct card / Drug card

A pay-direct card, also known as a drug card, is a plastic or digital card issued by your health insurance provider that allows pharmacies to bill your insurer directly for eligible prescription drugs. Instead of paying the full cost upfront and submitting a claim later, you pay only your portion - such as a deductible or coinsurance - at the point of sale.

Per Incident

Per incident refers to the way certain insurance benefits are calculated or limited based on each separate event, illness, or accident rather than by year or lifetime. When a benefit is paid “per incident,” it means you are eligible for reimbursement each time a new, distinct occurrence happens, up to the maximum amount specified for that type of claim.

Per Person / Per Family

Per person and per family describe how benefit limits, deductibles, or maximums are applied within a health or dental insurance plan. A per person limit means the specified amount applies individually to each insured member, while a per family limit represents the total combined coverage for all members under one policy.

Per-Practitioner Annual Maximum (Paramedical)

The per-practitioner annual maximum is the total amount your plan will reimburse for services from one specific type of provider in a single benefit year. For example, if your plan pays up to $500 for massage therapy annually, once that amount is reached, additional treatments from that provider type are no longer covered until the next year.

Have questions about your insurance coverage?

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