PRE-EXISTING CONDITION EXPLAINED

Pre-existing condition (PEC) - an illness or condition shall be considered pre-existing if before the Effective Date of the Agreement:

  1. Any professional advice or treatment was given for such illness or condition prior to effective date of coverage.

  2. Such illness or condition was in any way evident to the member prior to effective date of coverage.

  3. The pathogenesis of such illness or condition has already started prior to effective date of coverage.
    After the member has been continuously covered for 12 months and the agreement is renewed, the provision on PEC excluded from I-Care coverage shall be waived, provided that such PEC is not considered part of the "
    Permanent Exclusions to Health Care Coverage" and that such PEC was disclosed by the member in the original application.

Explanation:
Any illness, disease, or adverse health condition which a member has upon enrollment, whether he is aware of it or not, is not covered during the first year of membership. Upon renewal with I-Care the same may be covered subject to evaluation.

 

Examples of PECs are, but not limited to:

1.     Hernias

2.     All tumors and malignancies involving any body organ or system

3.     Endometriosis, Dysfunctional Uterine Bleeding

4.     Hemorrhoids

5.     Diseased tonsils requiring surgery

6.     Pathological abnormalities of the nasal septum and turbinates

7.     Thyroid Dysfunction /Goiter

8.     Cataract

9.     Sinus condition requiring surgery

10.   Asthma /Chronic Obstructive Pulmonary Disease

11.   Liver Cirrhosis

12.   Tuberculosis

13.   Anal Fistula

14.   Cholelithiasis /Cholecystitis

15.   Calculi of the urinary system

16.   Gastric or Duodenal Ulcer

17.   Hallux Valgus

18.   Diabetes Mellitus

19.   Hypertension

20.   Collagen Disease /Auto Immune Disease

21.   Cardiovascular Disease

22.   Hormonal Dysfunction

23.   Seizure Disorder /Cerebral Insufficiency /Stroke 

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