Covered for Acute Onset of Pre-Existing Conditions
A Pre-Existing Condition is an illness or other medical condition that was treated, diagnosed, or changed during a policy’s lookback period.
In addition to the Exclusions above, We will not pay Medical Expense Benefits, Transportation Expenses or Additional Benefits for any loss, treatment or services that is caused by, contributed by or that results from:
1. Pre-Existing Conditions, as defined.
“Pre-Existing Condition” means any medical condition, Sickness, Injury, Illness, disease, mental Illness or mental nervous disorder, for which medical advice, diagnosis, care or Treatment was recommended or received or for which a reasonably prudent person would have sought Treatment during the 36-month period immediately preceding the Effective Date of Coverage under this Policy.
Pre-Existing shall also mean any Injury, Illness, Sickness, disease, or other physical, medical, mental or nervous disorder, condition or ailment that, with reasonable medical certainty, existed at the time of Application or at any time during the 36 months prior to the Effective Date of this insurance, whether or not previously manifested, symptomatic or known, diagnosed, Treated, or disclosed to the Company prior to the Effective Date, and including any and all subsequent, chronic or recurring complications or consequences related thereto or resulting or arising therefrom.
Pre-Existing shall also include any Acute Onset of an Illness, Sickness, disease, or other physical, medical, mental or nervous disorder, condition or ailment that is an exacerbation of, due to, or associated with an underlying condition. Underlying condition shall include any condition that has been monitored by a Physician due to possible deterioration of the Covered Person’s diagnosis being changed, as a result of a previously known condition that can affect, degrade, and/or alter a Covered Person’s underlying condition, including any changes in medication.
ACUTE ONSET OF PRE-EXISTING CONDITION
For ages up to and including 69 the limit is up to the Medical Policy Maximum purchased per Policy Period except for any coverage related to Cardiac Conditions or Stroke, which will be limited to $25,000. Upon attaining age70 Acute Onset benefits will be reduced to a Maximum of $35,000 except for any coverage related to Cardiac Conditions or Stroke, which will be limited to $15,000.
ACUTE ONSET OF PRE-EXISTING CONDITION (PER POLICY PERIOD) Benefits are payable for an Acute Onset of a PreExisting Condition. Any repeat/reoccurrence within the same Policy Period will no longer be considered Acute Onset of a Pre-Existing Condition and will not be eligible for additional coverage. A Pre-Existing Condition which is a chronic or congenital condition or that gradually becomes worse over time and/or known, scheduled, required, or expected medical care, drugs or treatments existing or necessary prior to the Effective Date are not considered to be an Acute Onset. This benefit covers only one (1) Acute Onset episode of a Pre-Existing condition. Sudden and Acute Onset of a Pre-Existing Condition Coverage expires upon medical advice that the condition and onset is no longer acute, or the Covered Person is discharged from a medical facility.