Pre-existing Condition Exclusion

The Pre-existing Condition Exclusion that applies depends on the plan purchased.

Please see the definition of “pre-existing condition” and “stable”.

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 the six (6) months prior to the effective date.
  • your heart condition if, in the six (6) months before your effective date, you required any form of nitroglycerine for the relief of angina pain; and/or
  • your lung condition if, in the six (6) months before your effective date, you required treatment with oxygen or Prednisone for your lung condition.

Plan B – We will not pay any expenses relating to:
  • a pre-existing condition that is not stable in the six (6) months before your effective date; and/or,
  • your heart condition if, in the six (6) months before your effective date, it has not been stable or you have taken any form of nitroglycerine for the relief of angina pain; and/or,
  • your lung condition if, in the six (6) months before your effective date, it has not been stable or you required treatment with oxygen or Prednisone for your lung condition.

Pre-existing condition means a medical condition that exists before the effective date of insurance.

Stable means that all of the following apply:
  • there has not been 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 specialty clinic; and
  • a physician has not advised a visit to a specialist or to have further testing, and there has been no testing for which the results have not yet been received.