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Student Health Service

Pre-existing Conditions

STARTING WITH 2014-15, THERE ARE NO LONGER PRE-EXISTING CONDITION EXCLUSIONS

 

Are you over 19 and new to the 2013-14

Lewis & Clark Student Health Insurance Plan?

If so, you need to know whether pre-existing conditions are covered for you.  A pre-existing condition means a condition for which medical advice, diagnosis, care or treatment (including taking prescription medications) was recommended or received during the six months prior to the Effective Date of coverage.

Under the Lewis & Clark 2013-14 Student Health Insurance plan, if you are under age 19, there are no pre-existing limitations.

If you are 19 or older and new to the plan, there are pre-existing limitations.   For these individuals, pre-existing conditions are not covered for a period of six months after the Effective Date of coverage of their student medical insurance.

Credit will be given for the time an insured student is covered under Qualifying Prior Coverage if the overage was in force within 63 days prior to the effective date of your student medical insurance.

“Qualifying Prior Coverage” means any individual or group policy, contract, or program that is underwritten or administered by an insurer, nonprofit hospital service plan, care service plan, fraternal society, self-insured employer plan, or other type of entity that provides or arranges medical, hospital and surgical coverage, which does not supplement other private or governmental plans. This includes continuation or conversion coverage, but does not include accident-only, credit, disability income, Medicare Supplement, long term care, dental, vision, worker’s compensation or similar law, or any other publicly sponsored health program.

To obtain credit for “Qualifying Prior Coverage” you will need to request a “Letter of Creditable Coverage” from your current insurance carrier. This letter will show the effective dates that you were covered. When you receive the letter, submit it to Aetna Student Health at P O Box 981106, El Paso TX 79998.

If you have not had insurance within the 63 days before the effective date of your school’s coverage you will need to complete a claim form indicating when you were first treated (in regards to the claim submitted) and any doctors you have seen. Aetna Student Health will have to determine if this was a pre-existing condition by obtaining information from any physicians that have treated you.

If it is determined you are being treated for a pre-existing condition, any eligible expenses for that condition will not be covered until you have been on the student medical insurance for six (6) months.

FOR MORE INFORMATION ABOUT THIS COVERAGE CONTACT AETNA STUDENT HEALTH AT 1-877-375-7911.