2 AAC 39.370. Pre-existing condition limitation

(a) If major medical insurance coverage is elected during an open enrollment period, the new law benefit recipient and any eligible dependents are subject to a pre-existing condition limitation. Under this limitation, only the first $1,000 of covered medical expenses relating to a pre-existing condition will be paid by the insurer. After a person has been covered for 12 consecutive months, the limitation no longer applies.

(b) The pre-existing condition limitation does not apply to

(1) a new law benefit recipient who makes an election of major medical insurance under 2 AAC 39.310(a) ;

(2) a benefit recipient appointed to a disability benefit;

(3) a new law benefit recipient eligible due to reaching the age of 65; or

(4) an alternate payee.

(c) In this section "pre-existing condition" means a condition for which an individual has received diagnosis, tests, or treatment, including the taking of medication, during the three month period before the effective date of coverage.

History: Eff. 2/1/93, Register 125

Authority: AS 14.25.168

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