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Broadly speaking, a pre-existing condition is defined as a medical condition that you had before you took out your health insurance. It could be a health condition you were treated for or even something you went to your GP and asked for advice about.
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Most insurers won’t cover pre-existing conditions. Health insurance covers new conditions or injuries that begin after your cover starts. For example, if you took out health insurance in March 2024, it wouldn't cover an injury you got in January 2024.
It's designed to pay out if you were diagnosed with or undergo a medical procedure for one of the specified critical illnesses that we cover during the length of your policy and you survive for 14 days from diagnosis. Below is a complete list of the critical illnesses that are covered.
In the event of a loss, the policyholder carries the burden of proof to show that the loss suffered falls within the scope of the insuring clause or any extension of cover within the policy.
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Dec 30, 2023 · Stop loss in health insurance is a contractual provision that establishes a predetermined limit on an individual’s or employer’s financial liability for covered healthcare expenses. It acts as a safeguard against excessive medical costs that may arise from a severe illness, injury, or other catastrophic health events.
Jul 28, 2023 · Stop loss insurance protects self-insured employers from unexpectedly high medical costs. The concept is simple: The insurance company agrees to reimburse the bills — thus “stopping the loss” — if a business’s employees have out-of-pocket healthcare costs that exceed a pre-established threshold.
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Sep 18, 2020 · Put simply, a stop loss policy is a type of insurance coverage where the policy only pays after medical claims exceed a pre-determined amount.
