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 means a medical condition for which:
- there have been no new symptoms, and existing symptoms have not become more frequent or more severe or there has been no test results showing deterioration;
- a physician has not determined that the condition has become worse;
- a physician (or other medical professional) has not prescribed or recommended a change in medication taken for that condition meaning that the medication dosage or frequency has been reduced, increased, stopped and/or new medication(s) has (have) been prescribed. Exceptions: the routine adjustment of Coumadin, Warfarin, (as long as they are not newly prescribed or stopped) and a change from a brand name medication to a generic brand medication (providing the dosage and frequency of usage remain unchanged);
- a physician (or other medical professional) has not prescribed or recommended a change in treatment;
- there has been no admission to a hospital and you are not awaiting results of further investigations for any medical condition.
Other conditions, limitations and exclusions apply. Please see the policy for details.