WorldMed ^™

Acute Onset of a Pre-existing Condition – Covered up to $200,000 or $20,000 (depending on age)

WorldMed insurance includes coverage for acute onset of pre-existing conditions. To understand what an acute onset of pre-existing conditions is, it is necessary to know what a pre-existing condition is first.

Pre-existing Condition

Means any (1) Condition for which medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) was recommended or received during the 18 months immediately preceding the certificate effective date; (2) Condition that had manifested itself in such a manner that would have caused a reasonably prudent person to seek medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) within the 18 months immediately preceding the certificate effective date; or (3) Injury, illness, sickness, disease, or other physical, medical, mental, or nervous conditions, disorder or ailment (whether known or unknown) that, with reasonable medical certainty, existed at the time of application or within the 18 months immediately preceding the certificate effective date. For the purposes of the Complications of Pregnancy coverage offered hereunder, pregnancy will not be included within the definition of a pre-existing condition.

Acute Onset of a Pre-existing Condition

The term Acute Onset of a Pre-Existing Condition(s) shall mean a sudden and unexpected outbreak or recurrence of a pre-existing condition(s) which occurs spontaneously and without advance warning either in the form of physician recommendations or symptoms, is of short duration, is rapidly progressive, and requires urgent care. The Acute Onset of a Pre-existing Condition(s) must occur after the certificate effective date. Treatment must be obtained within 24 hours of the sudden and unexpected outbreak or recurrence. A pre-existing condition that is a chronic or congenital condition or that gradually becomes worse over time will not be considered Acute Onset. This benefit does not include coverage for known, scheduled, required, or expected medical care, drugs or treatments existent or necessary prior to the certificate effective date.

Acute Onset of pre-existing conditions is available for insured members age 14 days through age 59 inclusive, up to $200,000 per Certificate Period; for members age 60 through 64 inclusive, up to $20,000 per Certificate Period.

Conditions and Restrictions

YOU ARE COVERED:

1. Charges for a sudden and unexpected outbreak or recurrence of a pre-existing condition(s) which:
• Occurs spontaneously and without advance warning either in the form of physician recommendations or symptoms; and
• Is of short duration; and
• Is rapidly progressive; and
• Requires urgent care.

YOU ARE NOT COVERED unless you fulfill the following condition:

1. Treatment must be obtained within 24 hours of the sudden and unexpected outbreak or recurrence.

YOU ARE NOT COVERED IF:

1. The Acute Onset of a Pre-existing Condition(s) occurs before the certificate effective date; or
2. The pre-existing condition is a chronic or congenital condition or that gradually becomes worse over time; or
3. The charges are for known, scheduled, required, or expected medical care, drugs or treatments existent or necessary prior to the certificate effective date; or
4. Expenses arise directly or indirectly from anything in the General Exclusions.