Preexisting Condition Information

Please note: These plans exclude coverage for preexisting conditions for the first 12 months of coverage except for applicants under 19 and dependent children under 19. However, if you meet the requirements for creditable coverage, you may be able to reduce or waive the waiting period for your preexisting condition.

What is a preexisting condition exclusion?

A preexisting condition exclusion excludes coverage for a certain period of time for charges related to any medical condition or illness for which medical advice or treatment was recommended or received within a stated “look-back” period that precedes the effective date of coverage.

If you have prior creditable coverage, you may be eligible for a waiver of the preexisting condition exclusion.

What is creditable coverage?

Creditable coverage refers to health coverage that you have now or that you have had previously that meets certain conditions. The previous health plan must have been in force for a specified time period (12 months for a Blue Cross^® & Blue Shield^® plan and 18 months for other carriers’ plans). If the prior coverage was with a Blue Cross & Blue Shield plan it must have been in force continuously without a break prior to your current application. For other carriers’ plans the prior coverage must have been in force continuously without a break of more than 63 days prior to your current application.

Prior creditable coverage does not guarantee acceptance into this medically underwritten program. All applications are subject to underwriting approval. For more information, visit ibx.com and learn about guaranteed enrollment plans.

What kind of plans qualify as creditable coverage?

• group or individual health plans including governmental plans
• COBRA continuation coverage
• state high-risk pools
• Indian Health Service
• public health plans (such as a plan offered by a state)
• federal or state employee benefits
• Medicare
• Medicaid

Plans that do not count as creditable coverage include:

• accident only
• dental or vision only
• disability or liability plans
• auto or homeowners plans
• hospital indemnity
• Workers’ compensation
• specified disease policies (e.g., cancer policies)

What is needed to be considered for a reduction or waiver of the preexisting condition exclusion period?

• Be sure that you have fully completed all parts of Section G — Other Insurance.
• You must also submit a Certificate of Creditable Coverage for each applicant.