Does anyone understand this?

What does this mean..? A pre-existing condition exclusion may relate only to conditions manifesting in symptoms that would cause an ordinarily prudent person to seek medical advice, diagnosis, care, or treatment, or for which medical advice, diagnosis, care or treatment was recommended or received, during the twelve months immediately preceding the date of application or to a pregnancy existing on the effective date of coverage.

 

****) will not provide benefits for twelve months from the date of application for pre-existing condition or for complications or treatment arising from a pre-existing condition for any member without qualifying health insurance coverage within the ninety days preceding the date of application.

 

I'm no expert, but it sounds like they won't pay for "preexisting conditions" until you've had the policy in effect for over 12 months.  If you are looking for payment of WLS, morbid obesity would probably be a preexisting condition.  As far as the "prudent person" part; for an example:  if you have never been diagnosed with diabetes, but you've have no feeling in you feet and legsfor a couple of years, you will be labeled as a preexisting diabetic for insurance purposes and will not be eligible for payment of medical services related to such even though you've never been to the doc's office and never been given a diasnosis.  Yeah, it sucks.  :(

It is a 12 month pre existing clause: it means that if you have a pre existing condition like ex: diabetes, obesity, heart condition, high blood pressure.  From the date of your effective date the first 12 months will not cover anything pertaining to that PE condition.   Now the second paragraph says however if you have insurance with one carrier and move to another insurance if you do not have more than a ninety day lapse between coverages the pre existing can we waived based the number of months you had the other coverage ex:  if you had insurance 1 for 9 months then it cancelled and 1 month later signed up with insurance B then insurance B can give you credit on the back in for 9 months indicating you would only have a 3 month pre existing waiting peroid hope this helps

They can only exclude pre-existing conditions where there is a gap in coverage.  Not just because they feel like it.