Frequently Asked Questions  >  PA Pre-Existing Condition Limitations


PA Pre-Existing Condition Limitations

1. If an applicant is on a medication during the 90-day period prior to enrollment, does the use of that medication constitute “treatment received” for the purposes of the pre-existing condition exclusion?


2. How will IBC communicate to an applicant that his/her coverage is approved but that certain conditions are subject to the pre-existing condition exclusion?

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1. If an applicant is on a medication during the 90-day period prior to enrollment, does the use of that medication constitute “treatment received” for the purposes of the pre-existing condition exclusion?
   
   Yes, use of a prescription medication does constitute treatment received for purposes of pre-existing condition exclusion.
   
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2. How will IBC communicate to an applicant that his/her coverage is approved but that certain conditions are subject to the pre-existing condition exclusion?
   
   Upon approval, members will not receive a notice specifying the conditions subject to the pre-existing condition exclusion. The pre-existing condition exclusion will be applied through the IBC claims payment system.
   
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