PRE-EXISTING CONDITION

A pre-existing condition is a condition or injury requiring
treatment and/or management prior to the subscriber’s
effective date with the current insurer. Generally specific
time guidelines are stated qualifying at what point (if any)
the carrier will pay for services pertaining to this
condition or injury.
“Waiting Period” is the period of time from coverage
effective dates that insurer does not cover pre-existing
medical condition. The individual will normally be covered
for the condition once the specified time has elapsed. Also
called “Pre-existing Condition Exclusionary Period”.

Federal law defines a pre-existing condition as any
condition for which medical advice was given or
treatment was recommended by or received from a
physician within six months before the effective date of
coverage. Medigap insurers are required to reduce the
pre-existing condition waiting period by the number of
days an individual was covered under some form of
"creditable" coverage so long as there were no breaks in
coverage of more than 63 calendar days.

"A pre-existing condition is a medical condition that would
cause a normally prudent person to seek treatment during
the twelve months prior to the beginning of coverage."

Coverage Waivers: If you have a condition, illness, or
injury that can be identified as one that does not
necessarily affect your overall good health but could
affect risk balance of all insured's, Unicare may waive
that condition from coverage. This means that expenses
for treatment of that condition or any other condition
related to it will not be covered for a specified period of
time.