May 9, 2006
Hi Ms. Franzoi, could you please elaborate on the question asked on April 5. The question is titled "Pre-Existing Condition" I would really like to know more about this issue since I may be facing the same situation. I will appreciate any help. Thank you.
| Response from Ms. Franzoi
A pre-existing exclusion is a provision in a medical plan that excludes coverage for medical treatments related to a pre-existing condtion that the covered person had at the time coverage began. In most plans, this is defined as any condition for which you sought treatment, took medication or saw a physician for in the 90 days (time period can be longer) prior to the date coverage begins. If the plan has a pre-existing condition clause, it cannot be for a period greater than 12 months and must recognize any Creditable Coverage towards the exclusion period. Creditable Coverage is defined as coverage under a group health plan, Medicare, Medicaid. public, including federal, health plans, etc. Periods of Creditable coverage are aggregated. However, if you have a break in coverage greater than 63 days, coverage prior to the break does not count.
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