Question for me

[GoingNorth]

I just took a job that includes good health benefits. (HMO)

I have been off COBRA due to a rate hike that left me unable to pay the premiums. I am beyond my sixty day gap in coverage.

I have 'a knee' that needs either yet another 'clean up' surgery or replacement. It will need replacement eventually one way or the other.

My question is this: It is obviously a pre-existing condition (the problem dates back to a severe injury and subsequent surgeries starting in '79)

WI law is vague on pre-existing conditions. What exactly defines a pre-existing condition? I have a twelve month waiting period (not a problem unless a very worn out tendon or ligament graft decides to blow out) on those conditions. My concern is that I could put a foot wrong or stumble or something and totally wreck what's left of my knee...would it be covered?

I have not had an official Dr's visit or tx for my knee in the past year, but am on, and have refilled, prescriptions for medications for arthritis directly related to that knee. Does that qualify as 'being under care'?

Does my seeing a doctor up here for something utterly unrelated and on the forms mentioning that I have arthritis qualify as 'being under care'?

TIA
toK

 

[OTE]

Try your state dept of insur regulation. You're asking specific word definitions which would be determined by state law. Each state has a hotline in the dept of insur.

 

[bigblueagain]

I am going to say that most likely you would have to wait out your 12 mo period. HIPAA usually mandates unbroken period of coverage whether it be by COBRA or any other type of coverage. Since your policy already denotes the 12 mo waiting period, and this is an HMO type coverage, more than likely state laws won't supercede this. BLUE