Preexisting Condition means a condition for which medical advice, diagnosis, care, or treatment was recommended or received during the 6 months before the earlier of the:
• Effective date of coverage; or
• First day of the Waiting Period.
A pre existing condition is a medical condition that existed before you obtained health insurance. In most cases, there is a 9 month waiting period for pre existing medical condition coverage. That means that if a company offers you coverage, they may not provide coverage for that specific pre existing medical condition for 9 – 12 months.
In many cases, if have had coverage in place for at least 18 months with no more than a 63 day gap in coverage, and you are just switching insurance companies, the new company will give you credit for having coverage in place and waive the waiting periods for your conditions. This allows you to switch plans if you need to.
Remember, the idea for insurance is to protect yourself in case something bad happens. You don’t buy car insurance to cover the cost of oil changes for your car, you buy it for the really bad things that can happen. The same is true for health insurance. You need to have it in place before something bad happens. You can’t buy auto insurance after the accident to cover the cost of the accident. The same is true for health insurance
Preexisting Conditions Provision
Benefits for Eligible Expenses incurred for treatment of a Preexisting Condition will not be available during the twelve-month period following the Participant’s initial Effective Date, or if a Waiting Period applies, the first day of the Waiting Period (typically the date you are hired).
The Preexisting Condition exclusion will not apply to:
1. A newborn child who is added as described in Dependent Enrollment Period within the first 31 days after the date of birth; or
2. A child who is adopted or involved in a suit for adoption before attaining the limiting age shown in the definition of Dependent and who applies, as described in Dependent Enrollment Period, for coverage under this Contract; or
3. A court ordered Dependent of a covered Employee who applies for coverage as described in Dependent Enrollment Period; or
4. An individual who was continuously covered for an aggregate period of twelve months under Creditable Coverage that was in effect up to a date not more than 63 days before the Effective Date of coverage under the Health Benefit Plan, excluding any Waiting Periods.
The Carrier will credit the time you were covered under Creditable Coverage if the previous coverage was in effect under a Health Benefit Plan or self-funded Health Benefit Plan at any time during the twelve months prior to the Effective Date of coverage under this Plan. If the previous coverage was issued under a Health Benefit Plan, any waiting period that applied before that coverage became effective also will be credited against the Preexisting Condition exclusion.
Pregnancy, conditions resulting from domestic violence, and genetic information without a diagnosis of a specific condition shall not be considered a Preexisting Condition. All other terms, provisions, limitations, and exclusions will apply to all Participants even if any Preexisting Condition exclusion is not applicable for the reasons set out above.