§5-16-17 Preexisting conditions not covered; defined. - West-virginia Statutes

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Statutes > West-virginia > 05 > 5-16-17

§5-16-17. Preexisting conditions not covered; defined.
A preexisting condition is an injury, or sickness, or any condition relating to that injury, or sickness, for which a participant is diagnosed, receives treatment, or incurs expenses within three months prior to the effective date of coverage: Provided, That a preexisting condition shall not include a condition which meets the definition of handicap as provided in section three, article eleven, chapter five of this code. In determining whether the preexisting condition limitation provision applies to an eligible employee or dependent, the public employees insurance agency shall credit the time such person was covered under any previous employer-based health benefit plan, any comparable individual health benefit plan, or any self-insured plan if the previous coverage was continuous to a date not more than thirty days prior to the effective date of the new coverage, exclusive of an applicable waiting period under such plan.

For all participants enrolling in the plan after the effective date of this section, no payment shall be made for expenses incurred for or in connection with a preexisting condition unless the expenses are incurred after the expiration of a one-year period during which the participant is continuously participating in the plan.

State Codes and Statutes

Statutes > West-virginia > 05 > 5-16-17

§5-16-17. Preexisting conditions not covered; defined.
A preexisting condition is an injury, or sickness, or any condition relating to that injury, or sickness, for which a participant is diagnosed, receives treatment, or incurs expenses within three months prior to the effective date of coverage: Provided, That a preexisting condition shall not include a condition which meets the definition of handicap as provided in section three, article eleven, chapter five of this code. In determining whether the preexisting condition limitation provision applies to an eligible employee or dependent, the public employees insurance agency shall credit the time such person was covered under any previous employer-based health benefit plan, any comparable individual health benefit plan, or any self-insured plan if the previous coverage was continuous to a date not more than thirty days prior to the effective date of the new coverage, exclusive of an applicable waiting period under such plan.

For all participants enrolling in the plan after the effective date of this section, no payment shall be made for expenses incurred for or in connection with a preexisting condition unless the expenses are incurred after the expiration of a one-year period during which the participant is continuously participating in the plan.

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State Codes and Statutes

Statutes > West-virginia > 05 > 5-16-17

§5-16-17. Preexisting conditions not covered; defined.
A preexisting condition is an injury, or sickness, or any condition relating to that injury, or sickness, for which a participant is diagnosed, receives treatment, or incurs expenses within three months prior to the effective date of coverage: Provided, That a preexisting condition shall not include a condition which meets the definition of handicap as provided in section three, article eleven, chapter five of this code. In determining whether the preexisting condition limitation provision applies to an eligible employee or dependent, the public employees insurance agency shall credit the time such person was covered under any previous employer-based health benefit plan, any comparable individual health benefit plan, or any self-insured plan if the previous coverage was continuous to a date not more than thirty days prior to the effective date of the new coverage, exclusive of an applicable waiting period under such plan.

For all participants enrolling in the plan after the effective date of this section, no payment shall be made for expenses incurred for or in connection with a preexisting condition unless the expenses are incurred after the expiration of a one-year period during which the participant is continuously participating in the plan.