In general, a pre-existing condition exclusion means that if you have a medical condition before coming to our plan, you might have to wait a certain period of time before the plan will provide coverage for that condition.  This exclusion applies only to conditions for which medical advice, diagnosis, care or treatment was recommended or received within a six-month period prior to your effective date with Medica.

How do I know if a medical condition I have will or will not be excluded from coverage as a pre-existing condition?

Medical conditions that fit the "pre-existing" conditions definition are generally:

• Chronic
• Recurrent, and the a recurrence is likely to be related to prior occurrences
• Likely to have ongoing complications
• Permanent, irreversible, and likely to never resolve
• Long in duration prior to recovery

Conditions that are not considered to be pre-existing are generally:

• Episodic and recurrence is not likely to related to prior occurrences
• Short in duration
• Excluded from eligible benefits
• Required by State or Federal law
• Related to newborn status

If you have questions about whether or not your plan imposes a pre-existing condition exclusion, call Customer Service at the number on the back of your ID card.