Definition: A pre-existing condition is an injury or illness for which you or your dependent were treated or diagnosed within the 90-day period immediately preceding the earlier of 1) the effective date of your coverage under the plan or 2) any applicable waiting period. Pregnancy is not limited as a pre-existing condition. Genetic information is not considered a pre-existing condition in the absence of treatment or diagnosis related to that information.

How is coverage limited for a pre-existing condition? The PISD medical plan may not cover a pre-existing condition until you have been covered for 6 months. This 6-month limitation period may be eliminated or reduced if you had "creditable coverage" prior to becoming covered by the PISD plan.

How does prior "creditable coverage" reduce the limitation period? The 6-month limitation period will be reduced by any creditable coverage that you had under another plan within the 12 months prior to becoming covered by the PISD plan. Creditable coverage includes most types of comprehensive health coverage, including coverage under a group or individual health plan, Medicare, Medicaid, TRICARE, and CHIP.

How do I notify the plan about my creditable coverage? Your prior health plan sent you a “Certificate of Creditable Coverage” when your coverage with them ended. That certificate is required as proof of creditable coverage. When you submit a claim to CIGNA, you may include your certificates at that time. If no certificates are included with the claim, then you will receive a letter requesting the information. Once your certificates are received, the time period for your pre-existing condition limitation will be recalculated and claims will be reprocessed.

For complete information, please review the Plan document.

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