WHAT IS A PRE-EXISTING CONDITION?
This refers to a condition occurring during the 60 day period immediately prior to your effective date: 1) for which medical advice, care or treatment was received or recommended by a Physician regardless of whether or not a diagnosis was made; and 2) which produced symptoms or whose onset or manifestation occurred during such 60 day period. These symptoms must have been significant enough to establish manifestation or onset, which would have caused an ordinarily prudent person to seek diagnosis or treatment or enabled a Physician to diagnose such illness, disease, injury or other condition. A pregnancy that exists on the day before your effective date will be considered a Pre-Existing condition.
A pre-existing condition is evaluated by insurance carriers for both individual and family plans when writing coverage in the first 24 months of a policy. This limitation usually applies to any condition that is present, or has been treated within the last 6 months prior to the effective date. In order for a pre-existing condition to be covered an individual will have to be covered under a medical program for 12 or 24 months before any benefit is paid on that condition. • If I am covered under my employers plan do I need an individual plan? No. As long as you are a full time employee and meet the eligibility requirements of the plan there is no need for additional coverage on an individual basis. If however you want to supplement a group medical plan you may do so by purchasing a “wrap plan” which would be used to satisfy deductibles and or coinsurance percentages that would be paid by the individual. • If I have a family does my deductible apply to all family members? The deductible s
