Bookmark & SharePre-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.
Effective January 1, 2011, a pre-existing waiting period no longer applies to children up to age 19, including services for organ transplants. Basic Health waives the waiting period for routine diabetic care for a member diagnosed as a diabetic, or identified as a borderline diabetic by their contracted provider. Benefits and services now covered include diabetes education services approved by the health plan, yearly eye exam for diabetic retinopathy, and outpatient services related specifically to routine care.
Effective January 1, 2012, Basic Health enrollees are not subject to a pre-existing condition waiting period.
| 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. Children up to age 19 do not have a waiting period for organ transplant procedures.
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.
