Insurance Agent Forum

[headcoach]

When a policy has a 6 month waiting period for tonsils, appendix, etc, does the certificate of coverage remove the waiting period.

My understanding is that a CCC is for pre-ex, & technically the above is a waiting period, but shouldn't it be also satisfied by the CCC?

Any help on this would be appreeciated.

[STIBROKER@AUSTIN.RR.COM]

Originally Posted by headcoach

When a policy has a 6 month waiting period for tonsils, appendix, etc, does the certificate of coverage remove the waiting period.

No....it's it's own policy prevision.....and is a part of the policy...and does not fall under waiting period provision that creditable coverage deals with....

[healthagent]

For indie plans, creditable coverage does not matter - limitations, exclusions and waiting periods still apply.

[moonlightandmargaritas]

Originally Posted by healthagent

For indie plans, creditable coverage does not matter - limitations, exclusions and waiting periods still apply.

Some individual carriers in some states will credit toward the pre-x for previous, creditable coverage.

[TXINSURANCE]

Sti is correct if a policy has a separate fixed provision the COCC is useless.

[somarco]

Group or individual coverage?

[healthagent]

Originally Posted by moonlightandmargaritas

Some individual carriers in some states will credit toward the pre-x for previous, creditable coverage.

While this is true, like Aetna, is does not apply to policy provisions such as waiting periods for certain illnesses.

Assurant, for example, may accept creditable coverage but that doesn't negate the 3 month wait on hernias.

[moonlightandmargaritas]

Originally Posted by healthagent

Assurant, for example, may accept creditable coverage but that doesn't negate the 3 month wait on hernias.

I certainly hope you're not planning on getting one...

[healthagent]

Only if it's inguinal - then it's covered.

[TXINSURANCE]

This discussion is yet another fine example why individual policies should be standardized A to Z and identified as such to the consumer.

Virtually all policies are almost impossible to read and understand for the average consumer.

Imagine if Medicare was this hard.... Ohhh wait... never mind bad example.

[healthagent]

True...take GR's exclusion for reproductive disorders for six months that applies in some states. Are agents going over this with clients? A guess? What do you think.

Now clients have to read every line of the policy which carriers will say is their responsibility - which is kaka unless you're having an attorney translate it in many cases.

So why even the six month clause? Go figure - can't answer questions like that.

[TXINSURANCE]

So why even the six month clause? Go figure - can't answer questions like that.

Because "female" issues are some of the highest claim issues on individual policies. People often buy these policies when they are having issues in that area - some documented, some not documented.

Huge claim loss.

[Peelerinsurance.com]

John, the reason for the 6 month wait is most all the conditions that have th 6 month wait can and do get self diagnoised. also most of those conditions are not life threating and realy dont need a doctor to tell them they have it. a client without coverage will only get health insurance to cover the condition.

[TXINSURANCE]

Yep.

Well said Peeler.