Pre-Existing Medical Conditions
What Are Pre-Existing Medical Conditions?
A pre-existing condition is a physical or mental condition, regardless of the cause of the condition, for which medical advise. diagnosis, care, or treatment was recommended or received within the 6 month period immediately prior to the date the Member first becomes covered by this Contract.
The time used to satisfy any applicable waiting period will be credited to the preexisting condition limitation period. No waiting period credit will apply to late enrollees. The preexisting condition limitation does not apply to pregnancy or to a newborn, an adopted child under age 18, or a child placed for adoption. underage 18,jfthechildbecomes covered under Creditable Coverage within 31 days of birth; adoption, or placement for adoption. Genetic information will not be treated as a preexisting condition in the absence of a diagnosis of the condition related to that information. The preexisting condition limitation does not apply to eligible individuals and any eligible dependents enrolling for coverage under a special enrollment-period. With respect to timely enrollees, treatment received after the Member's, Effective Date of Coverage; and before the end of the 12 month period after the earlier to occur of the Member's Effective Date of Coverage, or' enrollment date; related to a preexisting condition that manifested itself during the 6 month period immediately preceding the Member's enrollment date, will not be covered. HMO waives this preexisting condition limitation provision if, under a prior group or individual health benefits plan, there has been a significant' break in coverage for not more than a 90 consecutive day period, except that neither awaiting period nor an affiliation period is taken into account in determining a significant break in coverage. The preexisting condition limitation period will be reduced by the number of days of prior Creditable Coverage the Member has as of the Effective Date of Coverage under this Contract or the first day of a waiting period.
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