Print this pagePre-Existing Conditions
You must wait nine months from the day your coverage begins before Basic Health will cover pre-existing conditions, except for maternity care and prescription drugs.
If you had coverage similar to Basic Health coverage (including Healthy Options or another Department of Social and Health Services [DSHS] program with similar coverage) any time in the three months just before you applied for or were enrolled in Basic Health, your waiting period for treatment of a pre-existing condition will be shorter. If your enrollment was delayed because Basic Health was full, you may receive up to three months' credit toward the waiting period. The table below gives examples of how this works.
| Previous similar coverage | Months credited toward the nine-month waiting period for pre-existing conditions |
|---|---|
| Continuous coverage in effect within three months of either the date Basic Health receives your application or the date your coverage begins. | One month credit for each month of continuous coverage. |
| Coverage during both the three months before your application was received and the three months before your coverage begins, with a break in coverage. | One month credit for each month of continuous coverage during the longer of the two coverage periods. For example, if you had three months' continuous coverage before your application date, and two months' coverage before your Basic Health coverage began, credit would be given for three months' coverage. |
Waiting Period for Organ Transplant Procedures
You must be enrolled in Basic Health for 12 months in a row before you're covered for organ transplant procedures, unless:
- The transplant is for a condition that was not pre-existing; or
- The transplant is for a child who has had Basic Health coverage since birth; or
- The transplant is for a child placed for adoption in the home of a Basic Health member within 60 days of birth and the child is continuously covered by Basic Health from the date of placement, if one or both of the adoptive parents were enrolled in Basic Health when the child was placed.
The waiting period for coverage of organ transplants will not be waived or reduced because of either:
- Other similar coverage in effect before your Basic Health enrollment; or
- Time spent waiting for Basic Health coverage.
