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EDUCATING INDIVIDUALS AND FAMILIES ABOUT APPROPRIATE AND AFFORDABLE
MEDICAL / HEALTH INSURANCE OPTIONS

Anthem Blue Cross and Blue Shields Pre-Existing Condition Clause for Ohio, Kentucky, and Indiana

Preexisting Condition Clauses vary from state to state, but the basic concept is:

If you have not had coverage in the past 63 days, then you are subject to a look back that determines how far the insurance company will not cover the expenses related to the condition going forward.  The expenses related to the condition include all services and prescriptions. 

Therefore, it is impotent to choose a plan that will best suit your need to pay for the preexisting conditions in addition to the covered services.  One company that does a great job of advising you in these situations is http://www.healthinsurancechaser.com/ (Phone: 1.877.775.4321).  Because no policies are created equal, it is important to speak with an unbiased health insurance advisor about your specific situation.

Here are a few state specific examples of how the preexisting condition clause reads with Anthem Blue Cross and Blue Shield:

 

KENTUCKY LANGUAGE

A pre-existing condition is defined as a condition (mental or physical) that was present and for which

medical advice, diagnosis, care or treatment was recommended or received within the six-month period

ending on the Enrollment Date. Pregnancy that exists on the effective date is considered a pre-existing

condition. Domestic violence is not considered a pre-existing condition. Genetic information may not be

used as a condition in the absence of a diagnosis.

Pre-existing conditions are only covered after the coverage has been in force for 12 consecutive months

following the effective date of coverage. Credit for a prior carrier’s coverage may be given, if that

coverage was continuous to a date not more than 63 days prior to Anthem’s receipt date of a completed

application.

 

INDIANA LANGUAGE

A pre-existing condition is defined as an illness, injury or condition which within the 12-month period,

depending on the policy prior to the effective date, manifested itself in such a manner as would cause an

ordinary prudent person to seek medical advice, diagnosis, care or treatment for which medical advice,

diagnosis, care or treatment was recommended or received. Pregnancy, in addition, which exists on the

effective date, is also considered a pre-existing condition.

Pre-existing conditions are only covered after the coverage has been in force for 12 consecutive months,

following the effective date of coverage. Credit for a prior carrier’s pre-existing period may be given, if

that coverage was continuous to a date not more than 63 days prior to Anthems’ receipt date of a

completed application.

 

OHIO LANGUAGE

A pre-existing condition is defined as an illness, injury or condition which within six months prior to the

effective date manifested itself in such a manner as would cause an ordinary prudent person to seek

medical advice, diagnosis, care or treatment or for which medical advice, diagnosis, care or treatment

was recommended or received. Pregnancy, which exists on the effective date, is also considered a preexisting

condition.

Pre-existing conditions are only covered after the coverage has been in force 12 consecutive months,

following the effective date of coverage. Credit for a prior carrier’s pre-existing period may be given, if

that coverage was continuous to a date not more than 63 days prior to Anthem’s receipt date of a

completed application.

 

Tri-State

Prior coverage can be from a group, individual or short-term contract, (Medicaid qualifies as prior

coverage) but it must be a major medical type policy. To apply for pre-existing credit, the applicant must

complete the section for prior coverage information on the application. Credit is not available if the prior

coverage was an indemnity plan, hospital only plan or supplemental policy.

Short-Term

A pre-existing condition is an illness, injury or condition, which within 24 months prior to the effective

date, manifested itself in such a manner as would cause an ordinarily prudent person to seek medical

advice, diagnosis, care or treatment or for which a medical advice, diagnosis, care or treatment was

recommended or received. Pregnancy, which exists on the effective date, is also considered a preexisting

condition. Pre-existing conditions are not covered for the term of the certificate. If you become

pregnant during the term of coverage, the plan only covers complications

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