• An illness or condition shall be considered pre – existing if, prior to the effective date of the Member’s health coverage or the approval date:

– Any professional advice or treatment was given for such illness or condition;

– Such illness or condition was, in any way, evident to the Member or upon medical examination in connection with the – Member’s application; or,

– Pathogenesis of such illness or condition has started whether or not the Member is aware of such illness.

• The following, among others, when occurring during the first year of coverage after the effective date, are considered Pre – existing:

– Hernias

– Cancer / Tumor / Neoplasms

– Endometriosis

– Hemorrhoids

– Ear-Nose-Throat conditions requiring surgery

– Hyphothyrodism / Hyperthyrodism / Goiter

– Cataracts / Glaucoma

– Epilepsy

– Asthma

– Cirrhosis of the Liver

– Tuberculosis

– Anal fistulae

– Cholecystitis / Cholelelithiasis

– Calculi of the urinary system

– Gastric / Duodenal Ulcer

– Hallux Valgus 

– Diabetes Mellitus

– Hypertension

– Collagen diseases

– Cardiovascular diseases

An illness or condition shall be considered pre existing if, prior to the effective date of the member’s health coverage (Membership Agreement) or prior to the approval date:

1. – Any professional advice or treatment was given for such illness or condition;
2. – Such illness or condition was in any way evident to the member or upon medical examination in connection with the member’s application; or,
3. – The pathogenesis of such illness or condition has started whether or not the member is aware of such illness.

The following conditions, among others, when occurring during the first year of coverage after the Effective Date, are considered Pre-existing: (a) hernias; (b) cancer or tumor or neoplasms; (c) endometriosis; (d) hemorrhoids; (e) ear-nose–throat conditions requiring surgery; (f)hyphothyroidism/hyperthyroidism/goiter; (g) cataracts and glaucoma; (h) epilepsy; (i) asthma; (j) cirrhosis of the liver; (k)tuberculosis; (l) anal fistulae; (m) cholecystitis/cholelelithiasis; (n)calculi of the urinary system; (o) gastric or duodenal ulcer; (p) hallux valgus; (q) diabetes mellitus; (r) hypertension; (s)collagen diseases (t) cardiovascular diseases.