ARE PRE-EXISTING CONDITIONS COVERED?
To keep our premiums lower and payouts higher, all of our plans exclude conditions that are pre-existing to your plan’s inception date. Ongoing conditions are excluded at your plan’s renewal date unless (1) 180 days have passed since cure and last treatment, (2) you choose our Sterling Plan, or (3) add our optional Continuing Care coverage. Find out more about our exclusions or view our plans for more details.
A. Pre-existing conditions are not covered. This includes any condition or complication that was treated or produced symptoms five years prior to your Secure STM effective date. The pre-existing condition limitation may vary by state. If you or a dependent have an existing health condition, you may want to consult with your independent insurance agent prior to applying for or changing health/medical insurance. Insurance fraud is a crime. Any person who, with intent to defraud or knowingly facilitates a fraud against an insurer, submits an application or files a claim containing false, deceptive and/or incomplete information is subject to civil and criminal prosecution.
There are no exclusions for pre-existing conditions if you’ve had continuous coverage with no lapse prior to your City coverage going into effect. Under the Premera Blue Cross plans, if you haven’t had continuous coverage there is a 3-month waiting period for all pre-existing conditions. The waiting period may be reduced by prior periods of creditable coverage. Group Health covers eligible pre-existing conditions at 100%. Back to Top Q: How do you receive care? A: You will maximize your benefits by utilizing a Premera “Participating” or “Preferred” Providers, specific to the plan you have selected. Simply present your I.D. card, and these “Participating” or “Preferred” providers will submit the claims for you. A Group Health member must contact a Group Health facility for care. A listing of these providers is available online.
Benefits under the Hospitalization or Surgery provisions of the plan are not payable for a pre-existing condition for the first 12 months following an insureds effective date. If an insured has a HIPAA certificate they will be given credit for credible coverage for the total amount of months shown on the certificate.
The Humana/CompBenefits Federal Advantage plan covers pre-existing conditions. In addition, you can see a list of what you will pay for each dental procedure, so you can get an idea of how much money you will save when you enroll in this affordable plan. You can review the list of procedures by going to the Copayment Schedule.
