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If a member has an accident or develops a medical condition during the year that will require additional treatment after the policy end date, they will have guaranteed acceptance with the pre-existing condition covered with any of the 50+ ACA plans effective January 1, 2021.
No benefits are payable for pre-existing condition expenses.
Pre-existing condition definition – A condition: (1) for which medical advice, diagnosis, care, or treatment was recommended or received within the 24 months immediately preceding the date the covered person became insured under the policy; (2) that had manifested itself in such a manner that would have caused an ordinarily prudent person to seek medical advice, diagnosis, care, or treatment with the 12 months immediately preceding the date the covered person became insured under the policy; or (3) a pregnancy existing on the effective date of coverage will also be considered a pre-existing condition.
Preexisting conditions, and complications resulting from a preexisting condition, will not be covered under the policy.
A “preexisting condition” means:
A. A condition for which medical advice, diagnosis, care, or treatment was recommended or received within the 24 months immediately preceding the date the covered person became insured under the policy.
B. A condition that had manifested itself in a manner that would have caused an ordinarily prudent person to seek medical advice,
diagnosis, care, or treatment within the 12 months immediately preceding the date the covered person became insured under the policy; or
C. A pregnancy existing on the effective date of the coverage.
November 1 Insurance companies release 2019 plans and rates
November 6 Health Insurance Advisors begins Client Advisory Service Consultations
December 15 Open Enrollment ends
Pivot Health members can see any doctor and go to any hospital. Pivot Health fee schedule for doctors is 125% more and hospitals and facilities 150% more than the Medicare fee schedule.” Doctors and hospitals have approximately 30% – 35% of their patients on the Medicare fee schedule.
Pivot Health members can see any doctor and go to any hospital. Pivot Health fee schedule for doctors is 125% more and hospitals and facilities 150% more than the Medicare fee schedule.” Doctors and hospitals have approximately 30% – 35% of their patients on the Medicare fee schedule.