Pre-Existing Condition

Pre-Existing Condition Limitations

Benefits for pre-existing conditions are limited to a maximum of $2,000 for covered expenses. This limitation will apply upon reinstatement of coverage following a break of more than six (6) consecutive months. Note: The pre-existing condition limitation does not apply to children under age 19.

No further benefits are payable for a pre-existing condition until you or your dependent have:

• gone six months without treatment for the pre-existing condition; or
• been continuously covered by the Plan for 12 months.

The pre-existing condition limitation excludes:

• Covered maternity expenses incurred by a participant or spouse
• Covered expenses for a newborn or newly adopted child enrolled within 30 days
• Life insurance
• AD&D insurance
• Weekly disability benefits for a period of disability beginning on or after the effective date of coverage
• Vision care
• Dental care.

This period is reduced by any period of credible coverage under a group health plan, health insurance policy, Medicare, Medicaid, or a state or federal health benefit plan, provided there is less than a 63-day break in coverage.