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Pre-Existing Condition Exclusion
Under Anthem Lumenos Indiana Health Insurance coverage, a pre-existing condition is defined as:
- a condition for which medical advice, diagnosis, care, or treatment was recommended or received during the twelve (12) months immediately preceding the member's effective date under the policy, or
- a pregnancy existing on the member's effective date under the policy, if maternity related benefits are provided under the policy.
Under the Anthem Lumenos plans, Anthem will not cover any sickness or injury which is caused by, or results from, a pre-existing condition in the first 12 months of coverage under the health insurance policy.
Anthem Exclusion Exception
Anthem will credit, against the 12-month pre-existing condition exclusion waiting period, time a member was covered by a prior qualifying health insurance plan. In providing this accommodation, Anthem follows guidelines of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), though HIPAA does not mandate health insurers to follow this procedure in administering non-group polices. We commend Anthem for their consumer-friendly stance.
