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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.
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.
November 1 Insurance companies release 2019 plans and rates
November 6 Health Insurance Advisors begins Client Advisory Service Consultations
December 15 Open Enrollment ends
a. Charges resulting directly or indirectly from a condition for which a Covered Person received medical treatment, diagnosis, care or advice within the sixty-month period immediately preceding such person’s Effective Date are excluded for the first 12 months of coverage hereunder.
b. Pre-existing conditions includes conditions that produced any symptoms which would have caused a reasonable person to seek diagnosis, care or treatment within the sixty-month period immediately prior to the coverage effective date