Unexpected Recurrence of a Pre-Existing Condition - Covered up to $20,000 for Ages Below 65 Years; Ages 65 and up Covered up to $2,500
The Diplomat International plan includes coverage for the unexpected recurrence of a pre-existing condition for insured persons. If you are considering this plan, it is important to know what a pre-existing condition is first to better understand what the Unexpected Recurrence coverage offers.
Pre-existing Condition
Pre-Existing Condition means an Injury, Sickness, disease, or other condition during the 12 month period immediately prior to the date the Plan Participant's coverage is effective for which the Plan Participant:
- received medical advice or received a recommendation for a test, examination, or Medical Treatment for a condition which first manifested itself, worsened or became acute or had symptoms which would have prompted a reasonable person to seek diagnosis, care or treatment or
- took or received a prescription for drugs or medicine.
Unexpected Recurrence of a Pre-Existing Condition
When Eligible Expenses of an Injury or Sickness of the Plan Participant who is a U.S. Citizen is not covered under the Plan Document due to a Pre-Existing Condition, as defined under this Plan Document, the Company will pay Usual Reasonable and Customary eligible expenses excess of the Deductible and Coinsurance as stated in the Schedule of Benefits. In no event will the Company's maximum liability exceed the maximum stated in the Schedule of Benefits as to Eligible Expenses during any one period of individual coverage.
To be eligible for benefits for an Unexpected Recurrence the following conditions and restrictions must be met at the time of the Unexpected Recurrence of the Pre-existing Condition:
- The Plan Participant must not be traveling against or in disregard of the recommendations, established Treatment programs, or medical advice of a Physician or other healthcare provider; and
- The Plan Participant must not be traveling with the intent or purpose to seek or obtain Treatment for the Pre-existing Condition; and
- The Plan Participant must not be traveling during a period of time when the Plan Participant is preparing or waiting for, involved in, or undertaking a new, changed or modified Treatment program with respect to the Pre-existing Condition, and is not traveling subsequent to any such new, changed or modified Treatment program having been advised or recommended; and
- The Pre-existing Condition must have been stabilized for at least thirty (30) days prior to the Effective Date without change in Treatment; and
- A Pre-existing Condition that is a Chronic or Congenital Condition, or that gradually becomes worse over time will not be considered a Sudden Recurrence.