Anthem BlueCross and BlueShield - Pre-Existing Conditions
Under the Anthem Colorado Health Insurance 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 Colorado defines 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.
Pre-Existing Condition Exception
Anthem has a very favorable pre-existing condition exception. Anthem will credit the time a member was covered by a prior qualifying health insurance plan against the 12-month pre-existing condition exclusion waiting period. For example, if I person was insured on an employer-sponsored plan for 6 months prior to obtaining an Anthem Blue Cross and Blue Shield health insurance policy, any pre-existing condition would be covered under their Anthem policy after 6 months instead of 12 months.
By providing this exception, Anthem follows the guidelines of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) even though HIPAA does not mandate health insurers to follow this procedure in administering individual policies, making this consumer-friendly extremely rare.
Medical Condition Rejection List
If you have a condition, illness, or injury that is listed on the Medical Condition Rejection List below, you will most likely be declined for individual coverage with Anthem Blue Cross Blue Shield of Colorado.
These conditions include, but are not limited to:
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