Medical Condition

A medical condition refers to any illness, injury, disease, disorder, or ongoing health issue that affects a person’s physical or mental well-being. In the context of insurance, the term includes both acute and chronic conditions, whether diagnosed, treated, or undiagnosed at the time of application or claim. Examples include high blood pressure, diabetes, asthma, depression, or past surgeries.

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Medical conditions are a key factor in underwriting and claims assessment. Insurers use information about your medical history to determine eligibility, premium rates, and coverage terms. Some policies, especially medically underwritten plans, may exclude coverage for pre-existing medical conditions or impose waiting periods before related claims are covered. In contrast, guaranteed issue plans typically cover pre-existing conditions after a defined stability period or at reduced benefit levels.

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Example:

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If you have been treated for asthma, that is considered a medical condition. When applying for health insurance, the insurer will use that information to evaluate your application and determine whether asthma-related expenses are covered.

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What to Watch For:

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Always disclose all known medical conditions and treatments when applying for insurance. Failure to do so may result in denied claims or cancellation of coverage. Keep documentation from your healthcare providers, as insurers may request medical reports or test results during underwriting or when reviewing a claim.