Q. What if I have pre-existing conditions? What are pre-existing conditions?
A pre-existing condition is any sickness or injury that existed prior to the effective date of coverage with Humana for which the covered employee, spouse, or dependent received medical attention. Humana excludes pre-existing conditions from coverage for a length of time that is defined in the member's contract. This time period for pre-existing conditions starts on the effective date of coverage. If the claim's date of service is within the pre-existing time span and the diagnosis could be related to a pre-existing condition, the claim may be investigated.
A pre-existing condition does not void all insurance coverage; it limits coverage for a specific condition up to the pre-existing provision on the plan.
A member's plan is not subject to the pre-existing condition if the member had coverage immediately prior to the new plan. However, there may still be a waiting period for a pre-existing condition even if you had prior coverage. A certificate of prior coverage from the previous insurance company is evidence of prior coverage.
For more information about pre-existing conditions, contact your Benefits Administrator.
