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Coverage before testing Postive
Aug 12, 2005

Thank You for all your help. I have a question regarding timing of insurnace and testing positive. I had an exposure about months ago and showing symptoms. I tested negative at 4 months under my old insurance. If I test postive under my new inusrance in two months from now, will my insurance company say that was a prexisiting condition. I have a test in my record from my doctor that I was negative at 4 months. Thanks

Response from Ms. Franzoi

The following is based on coverage under a group health plan: If your new insurance has a pre-existing condition clause (not all health plans do), any condition for which you took medication or saw a doctor for during the 90 days prior to your coverage commencing would be considered a pre-existing condition. However, a plan cannot apply a pre-exsitiing condition exclusion for greater than 12 months and it must recognize prior coverage (Creditable Coverage under HIPAA) towards that 12-month period unless you had a break in coverage of greater than 63 days. If you have an individual policy, your new plan would probably have the same pre-exisitng condition definition explained above but you might not have Creditable Coverage to count towards the pre-exisiting condition exclusion period. Whether or not you have a pre-exsiting condition depends on whether or not you took medication or saw a doctor for a condition in the 90 days prior to coverage commencing.

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