This article discusses the limitations and exceptions for sharing if you have a pre-existing condition at the start of your membership.
Understanding pre-existing conditions
Pre-existing medical conditions are defined as conditions in which known signs, symptoms, testing, treatment, diagnosis, or use of medication occurred before your membership start date.
For parents who adopt a child, a pre-existing condition is any physical condition that you had reason to be aware of prior to being legally responsible for the child’s medical expenses, or prior to the child’s effective date within your membership.
There are specific waiting periods, limits for sharing bills, and exceptions related to pre-existing conditions. Pre-existing conditions with exceptions are:
- Type I diabetes. These bills are not eligible for sharing.
- Heart and cancer. These bills are subject to an extended waiting period from other pre-existing conditions.
- High blood pressure. These bills are eligible for sharing if the member has not received hospital treatment for this condition in the last 5 years and it is controlled through medication or diet.
- Elevated cholesterol. If you are taking a prescribed statin for a pre-existing condition such as arteriosclerosis, then these bills are eligible for sharing only after you meet the waiting period. These bills are eligible for sharing if you are taking a statin to control your high cholesterol after the general waiting period for new memberships.
Counteracting the limitations of pre-existing conditions
FlexShare™ is an optional add-on feature that offers additional support for sharing Needs associated with pre-existing conditions. Again, there are specific requirements, waiting periods, and sharing limits associated with this add-on feature.
As a member of REDEEM™ HealthShare reading and understanding the Sharing Guidelines is important.