Supplemental Information to be Included with the Universal Application
Important Information for Applicant and Eligible Dependents regarding the Preexisting Condition Exclusion and Initial Notice About Special Enrollment Rights
I. Preexisting Condition Exclusion Rules
This plan imposes a “preexisting condition exclusion.” This means that if you have a medical condition before coming to our plan, you may have to wait a certain period of time before the plan will provide coverage for that condition. This exclusion applies only to conditions for which medical advice, diagnosis, care, or treatment was recommended or received within a six-month period. Generally, this six-month period ends the day before your coverage becomes effective. However, if you were in a waiting period for coverage, the six-month period ends on the day before the waiting period begins. The preexisting condition exclusion does not apply to pregnancy nor to a child who is enrolled in the plan within 60 days after birth, adoption, or placement for adoption.
This exclusion may last up to 12 months from your first day of coverage, or, if you were in a waiting period, from the first day of your waiting period. Please refer to the application cover sheet for the specific duration of the plan's exclusion period. However, the length of this exclusion period is reduced by the number of days of your prior “creditable coverage.” Most prior health coverage is creditable coverage and can be used to reduce the length of the preexisting condition exclusion if you have not experienced a break in coverage of 63 days or more. To reduce the 12-month exclusion period by your creditable coverage, you should give us a copy of any certificates of creditable coverage you have. If you do not have a certificate, but you do have prior health coverage, we will help you obtain one from your prior plan or issuer. There are also other ways that you can show you have creditable coverage. Please contact us if you need help demonstrating creditable coverage.
II. Notice of Special Enrollment
If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing towards your or your dependents’ other coverage). However, you must request enrollment within 30 days after you or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).
In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 60 days after the marriage, birth, adoption, or placement for adoption.
Please contact the plan representative listed on the application cover sheet if you have any questions about the preexisting condition exclusion waiting period, creditable coverage, requesting special enrollment or obtaining more information.