Pre-Existing Condition
What is a pre-existing condition and does Apogee Health Direct restrict coverage for them?
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Last Update 4 tahun yang lalu
Your Essential (MEC Plus!) plan has no pre-existing restrictions for medical services performed in an outpatient setting.
Zion classifies any illness or accident for which a person has been diagnosed, received medical treatment, been examined, taken medication, or had symptoms for 24 months prior to the Effective Date. Symptoms can include but are not
limited to the following: abnormal discharge or bleeding; abnormal
growth; break; cut or tear; discoloration; deformity; full or partial
loss of use; obvious damage, illness or abnormality; impaired breathing;
impaired motion; inflammation or swelling; itching; numbness; pain that
interferes with normal use; unexplained or unplanned weight gain or
loss exceeding 20% of the total body weight occurring within a six-month
period; fainting, loss of consciousness, or seizure; or abnormal
results from a test administered by a medical provider.
Needs that result from a Pre-existing condition that existed prior to a Member’s
Effective Date (known or producing observable symptoms) are only
shareable if the condition appears to be fully cured and 12 months have
passed without any symptoms (either benign or deleterious), treatment,
or medication, even if the cause of the symptoms is unknown or
misdiagnosed.