Pre-existing Condition Clause - Program 3 Plus

This plan has a pre-existing condition waiting period (this does not apply to dependents under the age of 19).  This means that as a new enrollee, if you have been diagnosed with, or treated for a specific medical condition within six month’s of the commencement of coverage, there is no coverage for services or supplies related to THAT SPECIFIC CONDITION for a period of 11 months. Some or all of this waiting period may be offset by your prior insurance coverage if you have a 62 day (or less) break in coverage. Your prior insurance company will provide you with a certificate of creditable coverage, and you use this to have all or part of the waiting period waived.

For example, if you were covered by another group health plan (without a break in coverage of 63 days or more) for the 4 month period before your enrollment date, the 11 month waiting period would be reduced to 7 months.   If you were covered by another group health plan (without a break in coverage of 63 days or more), for 11 months or more immediately prior to your enrollment date, the entire waiting period would be waived.