Pre-existing conditions and individual health

Sep 9, 2008

  1. inthedark
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    inthedark New Member

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    hello, i have found some very useful information on this forum and was wondering if any of you seasoned agents could confirm some information i have been given (just looking for a second opinion.) my wife and i recently signed up for an individual policy with carolina care plan (we are in sc.) on the application we disclosed that she suffers from occasional migraines. the agent assured us that they dont exclude any pre existing conditions but when i got our policy it mentions a 12 month exclusion on pre existing conditions. she seems to think that this is directed towards items that were not disclosed in the application? I am confused as i previously had a policy that excluded the migraines permanently but did not exclude my high cholesterol (controlled without meds now) and they never pulled the pre existing card when i had claims for my meds. so, my experience leads me to agree with the agent but i just wanted to get some varying opinions. thanks.
     
  2. joshril
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    joshril Guru

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    Re: pre existing conditions and individual health

    Is the Carolina Care plan some type of Guaranteed Issue plan? Of course this question is best answered by an agent in your state, but if you've had what the Department of Insurance in Carolina (N or S?) deems to be creditable coverage, if the policy was not ridered, most likely there will be no waiting period or the waiting period will be reduced.

    Keep in mind, since I don't offer insurance in North or South Carolina, this is advice is worth what you paid for it...
     
    joshril, Sep 9, 2008
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  3. inthedark
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    inthedark New Member

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    Re: pre existing conditions and individual health

    no it's just a regular ppo (now part of medical mutual of ohio) the main reason we went with them was no riders and her rates werent even increased becuase of the migraines. does credible coverage apply to individual plans?
     
  4. joshril
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    joshril Guru

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    Re: pre existing conditions and individual health

    What state are you in?
     
    joshril, Sep 9, 2008
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  5. inthedark
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    inthedark New Member

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    Re: pre existing conditions and individual health

    south carolina
     
  6. joshril
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    joshril Guru

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    joshril, Sep 9, 2008
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  7. Dave020
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    Dave020 Super Moderator Moderator

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    Re: pre existing conditions and individual health

    If you have had prior coverage in the past 63 days, provide your agent with a copy of your ID card (old ones) and any information you have about the prior coverage.

    12-month waiting periods are not abnormal, it is a way for an insurer to lower initial risk on new policies. However, they give you credit towards that waiting period for your prior creditable coverage.
     
    Dave020, Sep 9, 2008
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  8. somarco
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    somarco That Medicare Guy

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    Re: pre existing conditions and individual health

    Seems like we have an SC agent or two on this forum. They are the ones to give you the best advice.

    The agent you were dealing with either doesn't have a clue or just flat out lied. Either way, you need a better agent.

    Some carriers, but not all, will give credit for prior coverage against the pre-ex waiting period. Medical Mutual also owns Consumer Life who is in GA. FWIW, they will give credit for prior coverage but that does not mean the same is true in SC with your carrier.
     
    somarco, Sep 9, 2008
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  9. moonlightandmargaritas
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    moonlightandmargaritas Guru

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    Re: pre existing conditions and individual health

    Migraines are NOT a condition. They are a symtom of a condition.
     
  10. Crabcake Johnny
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    Crabcake Johnny Guru

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