Anthem Pre-Existing Condition Exclusion

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What is a Pre-Existing Condition?

Under Anthem Blue Cross Blue Shield Indiana health insurance plans, a pre-existing condition can be described 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.

Under plans for Indiana residents, 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.

Exception under Age 19

The pre-existing condition limitation does not apply to applicants under age 19.

In the Event of Prior Creditable Coverage

Anthem will credit, against the 12-month pre-existing condition exclusion waiting period, time a member was continuously (no more than a 63 day gap) insured 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.

For example, if you enroll in an Anthem Blue Cross Blue Shield individual or family plan after being continuously covered for 10 months under an employer-sponsored health program, you will be considered to have satisfied 10 months of the 12 month pre-existing condition exclusion waiting period under your new Anthem Blue Cross Blue Shield policy.

No Exclusion Riders from Anthem

For applicants with certain pre-existing conditions, some health insurance companies may agree to issue a health insurance policy, but waive the pre-existing condition from coverage. That means the condition will not be covered even after 12 months have passed. This is known as an "exclusion rider." In Indiana Anthem does not participate in that practice.

If you have a pre-existing condition Anthem Blue Cross Blue Shield may decline to insure you (same as every other health insurance company) or assess an additional premium charge (same as every other health insurance company), but they will not amend the insurance policy with an exclusion specific to your pre-existing condition. Again, we commend Anthem for their consumer-friendly position on this common health insurance practice followed by most of their Indiana competitors.

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