Stable
as indicated on your medical statement summary (if applicable), means that during the specified period:
a. there has been no new treatment; and
b. there has been no change in treatment or change in treatment frequency or type; and
c. there have been no signs or symptoms or new diagnosis; and
d. there have been no test results showing deterioration; and
e. there has been no hospitalization; and
f. there has been no referral to a specialist (made or recommended) and you are not awaiting the results of further investigations performed by any medical professional.
Exceptions:
i. the routine adjustment of Coumadin, warfarin, or insulin (as long as the medication is not first prescribed or stopped during the 90 days prior to the effective date);
ii. change from a brand name medication to a generic medication provided the medication was not first prescribed during 90 days prior to the effective date and there is no increase or decrease in dosage;
iii. a minor ailment.
Other conditions includes Parkinson's disease, epilepsy, cerebral palsy, multiple sclerosis, brain injury or brain tumor, seizure disorder, Lou Gehrig's disease (ALS), Creutzfeldt-Jakob disease, Cushing's syndrome, Guillain-Barré syndrome (GBS), trigeminal neuralgia (TN or TGN).
Stomach, bowel, digestive, gastrointestinal disorder
includes any condition along the gastrointestinal tract (from the mouth to the anus) and can include (among others) esophagus disorder, stomach disorder, ulcer, hernia, irritable bowel syndrome (IBS), inflammatory bowel disease, gastrointestinal bleeds, gastritis, Chrohn's disease, Celiac disease, diverticulitis, ulcerative colitis, colitis, bowel obstruction, bowel resection or ostomy.
Exceptions:
The following conditions are not subject to any surcharge but must be noted in the note section of the medical questionnaire:
i. Gastroesophageal reflux disease (GERD); or
ii. removal of polyps during a routine colonoscopy where no signs or symptoms were present; or
iii. diverticulosis.
Pre-existing Medical Conditions
Expenses that are due to, contributed by, or resulting from pre-existing medical conditions, may qualify for coverage, if your pre-existing medical condition meets the stability period that applies to you.
Stability period:
If you are age 64 or younger on your effective date:
Pre -existing medical conditions that are stable for 90 days before the effective date qualify for coverage, up to the Sum Insured shown on your Confirmation of Coverage.
If you are age 65 or older on your effective date:
Pre -existing medical conditions that are stable for 150 days before the effective date qualify for coverage, up to the Sum Insured shown on your Confirmation of Coverage.
Stable:
To be considered stable during your stability period, your pre-existing medical condition or related conditions must not have resulted in any of the following:
1. New treatment (including new prescriptions),
2. Change in treatment including frequency, dosage (increase, or decrease, or stopping) or type (including prescriptions),
3. Signs or symptoms,
4. A new diagnosis,
5. Test results showing your condition is worsening,
6. Hospitalization,
7. A referral to a specialist, received or recommended, or
8. Waiting for any test results, further investigation, or surgery.
The following are considered stable:
• Diabetic Insulin users - Routine insulin adjustment not prescribed by your physician, as long as insulin was not first prescribed during your stability period,
• Coumadin, Warfarin users - Routine adjustment of these medications, as long as Coumadin or Warfarin were not first prescribed during your stability period,
• A change from a brand name medication to a generic medication, or
• Minor Ailments - a sickness or injury that ended more than 30 days prior to your effective date and did not require:
a) treatment (including prescriptions) for more than 30 consecutive days, or
b) more than one (1) follow-up with a physician.