07/31/2008
Changes to GMA reflect how we now credit pre-existing condition waiting periods
The pre-existing section of the master application has recently been updated for groups of 2-99 employees. The new guidelines, which became effective June 1, 2008, state the criteria required for appropriate documentation for previous qualifying coverage:
- The coverage for both employee and dependents is indicated by the employee on the enrollment application. Indication of coverage would be previous carrier name, effective date, type of coverage (medical or dental) and all person(s) covered, or
- A certificate of qualifying coverage is provided by the previous carrier, or
- Two monthly billings are obtained from the previous carrier confirming that employee/dependent coverage was active for both the beginning and most recent months of the look-back period. It will be assumed that members had coverage for the entire look-back period if their coverage is confirmed on both billings. Coverage for dependents can be assumed if both billings show the appropriate tier of coverage, such as "family" for any dependent or "employee and spouse" for spouses, etc., or
- When none of the above situations applies, the member must meet the standard waiting period: for groups of 2-50 it is nine months, and for groups of 51+ it's three months.
If you have questions, please talk to your Regence Sales contact.
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