Pre-Existing Clause?

[Catspan]

Does anyone know if someone going from a Humana MA to a United Of Omaha Med Sup (answered all health questions) and was issued the policy if any pre-existing conditions will be covered? (State of Ohio) His policy has not arrived yet and I am just nervous because he canceled his Humana and he is does have a heart situation that was not covered in the medical questions that was on the application and will be going for a consultation on Jan. 4th. He answered the questions honestly. So, once the policy is issued do they have to cover any pre-existing conditions? This is my first time writing a policy for United Of Omaha. Thank you for anyone that has worked with this company and can share anything with me.

 

[DS4]

The Humana MA would constitute "Creditable Coverage".
Therefore, no pre x clause on Med supp.

 

[G.Gordon]

The Humana MA would constitute "Creditable Coverage".
Therefore, no pre x clause on Med supp.

+1 Exactly right.

 

[Catspan]

Thank you for your replies. He is not "loosing creditable coverage" with Humana which then I know that no pre-existing conditions would apply. He is opting to just switch on his own? Does that make a difference?

 

[sman]

No it doesn't.

Thank you for your replies. He is not "loosing creditable coverage" with Humana which then I know that no pre-existing conditions would apply. He is opting to just switch on his own? Does that make a difference?

 

[Catspan]

Thank you again! So if he has to have heart surgery in January under his new Med Sup then it will be covered because he was issued the policy and any pre-existing conditions will be covered.

 

[DS4]

T He is opting to just switch on his own? Does that make a difference?

Voluntary or involuntary loss of Creditable Coverage, it doesn't matter.
No pre x.

 

[sman]

Is this a planned heart surgery? I overlooked the section where you stated he has a heart condition that isn't covered in the application AND that he has a consultation. Once I saw where you stated he answered honestly I didn't give it a second thought. UoO's Med Supp application asks the following:

Have you been advised by a physician to have surgery, medical tests, treatment or therapy that has not been performed?

Looks like this one may fall in that category. Your best bet is to call the carrier and speak to an underwriter.

But know this, if everything was answered honestly and they issue the policy, there is no pre-ex to worry about.

 

[G.Gordon]

Thank you again! So if he has to have heart surgery in January under his new Med Sup then it will be covered because he was issued the policy and any pre-existing conditions will be covered.

How many ways do we have to answer the same question?

 

[Russ]

Is this a planned heart surgery? I overlooked the section where you stated he has a heart condition that isn't covered in the application AND that he has a consultation. Once I saw where you stated he answered honestly I didn't give it a second thought. UoO's Med Supp application asks the following:

Have you been advised by a physician to have surgery, medical tests, treatment or therapy that has not been performed?

Looks like this one may fall in that category. Your best bet is to call the carrier and speak to an underwriter.

But know this, if everything was answered honestly and they issue the policy, there is no pre-ex to worry about.

I was just thinking how....if he had to have heart surgery in January...or even within a few weeks of the effective date...a chance of UoO APS'ing his provider/providers, to verify Mr. Policyholder qualified.

I've never had them APS an existing policy(with claims), fortunately.

I wouldn't completely rule it out. I agree, he/she should talk to an underwriter.