AGU San Francisco Limited Medical Indemnity Plan

Pre-Existing Conditions Limitation


Benefits are not payable for any loss caused by, or resulting from, a Pre-existing Condition, unless the loss is incurred at least 6 months after the covered person’s effective date. This provision applies only to the Hospitalization and Surgery benefits of the plan.

“Pre-existing Condition” means a medical condition, injury or sickness for which a covered person has been diagnosed or treated within the 6 months prior to their effective date under the plan.

The Pre-existing Condition Limitation will be waived for groups with 10 or more eligible employees. For groups with less than 10 eligible employees, the Pre-existing Condition Limitation can be waived – for initial enrollees only - if the employer previously provided similar coverage under another policy and there is no lapse in coverage between plans. In this case, any employees enrolled after the group’s initial effective date will be subject to the Pre-existing Condition Limitation.

 

The Limited Medical Indemnity Plan will not pay benefits for any loss, injury or sickness that is caused by, or results from:

  1. (1) to improve function.
  2. (2) to create a normal appearance, to the extent possible.

Top

Exclusions Specific To Dental Benefits

(applicable to Large Employer Plans only):

Top