Pre-existing condition exclusions
This policy will not pay any expenses or benefits relating to:
- A pre-existing condition which has not remained stable in the three (3) months before the effective date.
- Any pre-existing condition of a covered dependant that was not stable in the three (3) months before the date the dependant became covered under this policy.
- For covered dependants under two (2) years of age, any medical condition related to a birth defect whether genetic, acquired, or congenital.
means an injury, illness or symptom that exists before the effective date of insurance.
Stable means a medical condition for which:
- you have not had any new symptom(s); and
- existing symptom(s) have not become more frequent or severe; and
- your physician has not determined that your medical condition has become worse; and
- no test findings have shown that your medical condition may be getting worse; and
- you have not received, been prescribed, taken or had a physician recommend any new medication, or any change in medication. 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); and
- you have not received, been prescribed or had a physician recommend any new treatment or any change in treatment; and
- you have not been hospitalized or referred to a specialty clinic or specialist; and
- your physician has not advised you to see a specialist or to have further tests, and you have not undergone testing for which you have not yet received the results.