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:

  1. 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;
  2. 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
  3. 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:
  1. a pre-existing condition that is not stable in the 180 days before the effective date of insurance;
  2. 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
  3. 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:
  • you have not had any new symptom(s); and
  • existing symptom(s) have not become more frequent or severe; and
  • a physician has not determined 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 new treatment or any change in treatment; and
  • there has been no admission to a hospital or referral to a specialty clinic or specialist; and
  • a physician has not advised referral to a specialist or 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).