Preexisting Conditions

Q:  Will my preexisting conditions be covered by the C&MA Health Plan?

Preexisting conditions will be covered provided you present Certificate(s) of Creditable Coverage showing 12 months of prior coverage on a Qualified Health Plan with no gap in coverage

  • You can obtain Certificate(s) from your prior health plans.
  • Certificate must show continuous health coverage of at least 12 months immediately prior to enrolment effective date.
  • Certificate must be provided for each family member.
  • Creditable coverage must come from a qualified health plan.
  • Voluntary sharing health cooperatives cannot be considered creditable coverage.

Preexisting conditions will not be covered for up to a maximum of 12 months if you have less than 12 months’ continuous prior coverage.

  • Creditable coverage may reduce your period of preexisting condition limitations.
  • If you have a gap of 63 days or more during the 12 months prior to your first day of coverage, any coverage prior to the gap will not be credited.
  • Preexisting condition limitations will not exceed 12 months.
  • Preexisting condition limitations do not apply to new injuries or illnesses, pregnancy, or dental, vision, or prescription benefit.

Please note:  Effective January 1, 2011, enrolled dependents under the age of 19 will no longer have pre-existing condition exclusions. 

Q:  I’ve had continuous coverage for several years, but recently my family and I had no coverage for three months. Will my preexisting conditions be covered?

If you have a gap of 63 days or more between insurance plans, you do not receive credit for any coverage you had prior to the gap. This means your preexisting conditions will not be covered by the C&MA Health Plan for up to 12 months. However, if you had a few months’ coverage with another plan after the gap in coverage, that will reduce the 12 months before preexisting conditions are covered.

 

Q:  I had nine months of coverage with another plan (and no coverage before that). Will my preexisting conditions be covered?

If you have nine months of prior coverage with a qualified plan and then come immediately on the C&MA Plan, your preexisting conditions will not be covered for the first three months. After that they will be covered.

© 2010 Alliance Benefits Designed by eyespeak
Please Note: The information contained in this site is intended as a summary of benefits. It does not guarantee coverage. The Health Plan pays benefits for medically necessary services resulting from illnesses or injuries that are not work related, up to reasonable and customary limits. Even though a doctor recommends or performs a service for you or your covered dependent, this does not automatically mean the service is covered by the Plan. If you have any doubt about whether a proposed treatment or service is covered under the Health Plan, please contact the number shown on your ID card.