Human Resources

Q:

My health claims are not being paid becausethe carrier states it does not pay for pre-existing conditions. What does this mean and how can I correct it?



A:

For an employee or dependent who enrolls when he is first eligible, there is a 12-month waiting period before benefits will be paid for a pre-existing condition. A pre-existing condition is any illness or injury for which medical advice, diagnosis, care or treatment was recommended or received within the six months before the date the coverage became effective. Pregnancy is not considered a pre-existing condition.

This waiting period can be waived or reduced by providing a benefits counselor in the Office of Human Resources a creditable coverage letter or statement on letterhead from your former employer or insurance company that includes the date coverage began and ended, the names of those covered and the type of coverage.

If an employee or dependent is added during open enrollment, he/she is subject, as a late entrant, to an 18-month waiting period before benefits will be paid for a pre-existing condition.

Covered persons younger than 19 are not subject to any pre-existing condition exclusions.




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