Pre-Existing
Condition Limitation
2010 TRS-ActiveCare Medical Plan
Definition: A pre-existing condition is a condition for which you or your dependent received medical advice, diagnosis, care, or for which treatment was recommended or received during the six months before your effective date of coverage under TRS-ActiveCare.
If you or a dependent has a pre-existing condition before your TRS-ActiveCare medical coverage starts, TRS-ActiveCare may deny benefits for that condition until you have been covered 12 months by TRS-ActiveCare.
The pre-existing condition provision does not apply to employees that initially enroll when the district begins participating in TRS-ActiveCare or to new hires who enroll within 31 days after their actively-at-work date. Also, the pre-existing condition provision does not apply to a newborn child (see special rules in the TRS benefits booklet), a person who was covered for 12 months under creditable coverage, pregnancies, conditions resulting from domestic violence, genetic information without a diagnosis of a specific condition.
If you were covered by TRS-ActiveCare at any point in time since the program's inception in 2002, and have been hired by a different participating district or rehired by the same participating district, pre-existing limitation exclusions may apply. The pre-existing condition exclusion may also apply to employees or dependents enrolling in TRS-ActiveCare due to a special enrollment event, a future plan enrollment period, a transfer to another participating district.
Prior creditable coverage may be used to offset a pre-existing condition waiting period as defined by HIPAA, unless followed by a gap in coverage of 63 or more consecutive days. A 12-month pre-existing condition waiting period may apply
|
