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Pre-existing
Condition Limitations
Enrollment
in the CHP for the worker and/or eligible dependents through
Annual Open Enrollment is subject to a pre-existing condition
limitation period. A pre-existing condition is defined as
a medical condition where medical advice, diagnosis, care,
or treatment was recommended or received within the 6-month
period immediately prior to the person’s CHP enrollment
date. For example, if a person was treated for hyperthyroidism
in February 2005, but received no other treatment for that
condition between 7/1/05 and 1/1/06 (6-month period prior
to 1/1/06 enrollment date), and the condition re-occurs in
March 2006, it is not a pre-existing condition under this
definition. However, if the hyperthyroidism occurred and was
treated between 7/1/05 and 1/1/06, it is a pre-existing condition
and medical expenses for the condition would not be covered
(except for prescription drugs). |
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Pre-existing
condition limitations are not applied toward pregnancy, regardless
of whether a woman has had prior health coverage. If the worker
or a dependent has a pre-existing condition and had no other
health coverage in place prior to CHP enrollment, then there
will be no CHP coverage for the first 18 calendar months following
CHP enrollment for that particular condition. That means for
2006, if a pre-existing condition exists, a limitation period
from January 1, 2006 until June 30, 2007, would be in place
and would exclude basic medical, preventive medical, mental
health care, and substance abuse care for that particular
condition. The pre-existing condition limitation does NOT
apply to prescription drugs, dental care, and the Member Assistance
Program.
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The
pre-existing condition limitation period can be eliminated
or reduced if you or your dependents had prior health coverage
and a HIPAA certificate is provided to Concordia Plan Services.
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