Aug 19, 2013
The Pre existing condition exclusion. The policy will not cover any total or partial disability: 1. which is caused or contributed to by, or results from a pre existing condition; and 2. which begins in the first 12 months after the insured employee's effective date. I have worked for this company for over 5 years now, I've been diagnosed with chronic heart failure for the past 10 years, does this exclusion apply to me?
Response from Mr. Chambers
You have nothing to worry about.....regarding the disability benefits. The key is in the word "and" between #1 and #2. You have to meet BOTH conditions before a claim can be denied due to a pre-existing condition.
You do not meet #2 as you did not claim total or partial disability in the first twelve months of coverage, 5 years ago, so the pre-existing conditions exclusion does not apply to you.
HIPAA and medical billing
This forum is designed for educational purposes only, and experts are not rendering medical, mental health, legal or other professional advice or services. If you have or suspect you may have a medical, mental health, legal or other problem that requires advice, consult your own caregiver, attorney or other qualified professional.
Experts appearing on this page are independent and are solely responsible for editing and fact-checking their material. Neither TheBody.com nor any advertiser is the publisher or speaker of posted visitors' questions or the experts' material.