Pre-Existing Condition Exclusions
This policy will not pay any expenses or benefits relating to:
- A pre-existing condition which has not remained stable in the three (3) months before the effective date.
- Any pre-existing condition of a covered dependant and/or spouse that was not stable in the three (3) months before the date the dependant/spouse became covered under this policy.
- For covered dependants under two (2) years of age, any medical condition related to a birth defect whether genetic, acquired, or congenital.
Pre-Existing Condition means an injury, illness or symptom that exists before the effective date of insurance.
Stable medical condition means that all of the following apply:
- you have not had any new symptom(s); and
- existing symptom(s) have not become more frequent or severe; and
- your physician has not determined that your medical condition has become worse; and
- no test findings have shown that your medical condition may be getting worse; and
- you have not received, been prescribed, taken or had a Physician recommend any new medication, any change in medication. Exceptions: the routine adjustment of Coumadin, Warfarin, insulin to control diabetes (as long as the medication is not newly prescribed or stopped) and a change from a brand name medication to a generic brand medication (provided that the dosage is not modified); and
- you have not received, been prescribed or had a physician recommend any new treatment or any change in treatment; and
- you have not been hospitalized or referred to a specialty clinic or specialist; and
- your physician has not advised you to see a specialist or to have further tests, and you have not undergone testing for which you have not yet received the results.
Other conditions, limitations and exclusions apply. Please see the policy for details.