What is a preexisting condition?  How do the new rules regarding preexisting conditions affect your health insurance coverage?

There have been many questions about the new rules established by UT System regarding preexisting conditions and how those rules will affect your health insurance coverage under the UT Select plan. The following information can be found on Page 24 in your benefit plan handbook.  The handbook defines a preexisting condition and its provisions as it will be administered or applied by Blue Cross Blue Shield.

A Preexisting Condition is a medical condition that you (or a covered dependent) received treatment for or medical advice about in the three-month period immediately preceding your (or your covered dependent’s) enrollment in the UT Select plan.

Services for a condition determined to be preexisting will NOT be eligible for benefits for the first 12 months of enrollment.  This means that if the first claim is received by BCBS 10 months into the first 12 months of coverage and determined to be preexisting, no claims will be paid for the remaining 2 months.  If the first claim is received in the first month of coverage and determined to be preexisting, no claims will be paid for that claim for the remaining 11 months. 

This provision Does Not apply to:

• Any participant enrolled in the UT Select plan before June 1, 2001;

• Pregnancy;

• A newborn child who is added within the first 31 days after the date of birth;

• A child who is adopted or involved in a suit for adoption before attaining 19 years of age and who applies for coverage under this Plan; or

• A court ordered Dependent of a covered Employee who applies for coverage.

For further information, please contact the BCBS customer service unit at 1-866-882-2034 or Human Resources at extension 8809.

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