Pre-existing Condition Exclusion
The Pre-existing Condition Exclusion that applies depends on the plan purchased.
Plan A - we will not pay any expenses relating to:
any medical condition, diagnosed or undiagnosed, which existed or for which you sought or received medical advice, consultation, investigation, or for which treatment was required or recommended by a physician, within 180 days before the effective date of insurance;
any heart condition if, in the 180 days before the effective date, the applicant required any form of nitroglycerine for the relief of angina pain; and/or
any lung condition if, in the 180 days before the effective date, the applicant required treatment with oxygen or prednisone for a lung condition.
Plan B – we will not pay any expenses relating to:
- a pre-existing condition that is not stable in the 180 days before the effective date of insurance;
any heart condition if, in the 180 days before the effective date, the applicant required any form of nitroglycerine for the relief of angina pain; and/or
any lung condition if, in the 180 days before the effective date, the applicant required treatment with oxygen or prednisone for a lung condition."Pre-existing condition" is defined in the policy as a medical condition that exists before the effective date of insurance.
Stable means a medical condition for which:
- there has not been any new symptom(s); and
- existing symptom(s) have not become more frequent or severe; and
- a physician has not found that the medical condition has become worse; and
- no test findings have shown that the medical condition may be getting worse; and
- a physician has not provided, prescribed, or recommended any new medication, any change in medication;* and
- a physician has not provided, prescribed or recommended any investigative testing, new treatment or any change in treatment; and
- there has been no hospitalization or referral to a specialty clinic or specialist; and
- a physician has not advised referral to a specialty clinic or specialist for further testing, and there has been no testing for which the results have not yet been received.
*Exceptions: the routine adjustment of Coumadin, warfarin, insulin to control diabetes (as long as the medication is not newly prescribed or stopped) and a change from a brand-name medication to a generic brand medication (provided that the dosage is not modified).