How are Pre-Existing Conditions Handled by Blue Cross of NC?

This article will discuss how are pre-existing conditions handled by the Blue Cross and Blue Shield of North Carolina®, Blue Advantage® Plan in North Carolina?

For Blue Cross and Blue Shield of North Carolina®, they consider the following to be a pre-existing condition:

Pre-existing conditions are those for which medical advice, diagnosis, care or treatment was received or recommended within 12 months of the date that your Blue Advantage coverage begins. You may receive credit toward the 12-month waiting period if we receive your completed Blue Advantage application within 63 days of the termination of your previous health coverage.

That means that your pre-existing conditions will be covered by Blue Cross if you have had continuous coverage for 12-months and there was not a 63 day lapse.

Blue Cross cannot deny coverage for pre-existing conditions if you had creditable coverage previously. When BCBSNC® assigns a final premium rate to your policy, they will consider those pre-existing conditions in their pricing. If you have asthma, for example, they will cover the asthma and the medications related to the asthma, but they will need to charge more per month to cover the additional risk they are incurring.

Unlike most companies, Blue Cross and Blue Shield of North Carolina® does not eliminate coverage for pre-existing conditions. They do cover them with an increase in premium. Most other companies issue elimination riders. A temporary elimination rider could read similar to this: “For a period of two years, we will not cover your asthma condition nor any medications nor complications resulting from the condition.

After the two year elimination period has elapsed, you may request that they reconsider this condition and they may offer coverage. If during the two year period you did not have to see a doctor, did not have to take any medications for the asthma, or were essentially cured, they probably rule in the affirmative. If however, you continued to have to get treatment for your condition, they will likely deny coverage.

In summary:

* Pre-existing conditions may or may not be covered depending on whether you had coverage prior to applying for the Blue Cross Blue Advantage plan.
* The pre-existing condition will be considered when they assign a premium rate to your plan.
* After a period of 12 months, your pre-existing condition will be covered whether you had prior insurance coverage not.
* Unlike most other insurance companies, Blue Cross will not issue an elimination rider.

If you are a resident of North Carolina, be prudent and get quotes for coverage by the Blue Cross and Blue Shield of North Carolina® Blue Advantage® plan.

Richard Day has years of experience finding the exact plan that will fit his client’s needs. He specializes in Blue Cross plans and will help you to understand how they work. For more information concerning the Blue Advantage® plans visit Blue Advantage Plans


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9 Responses to “How are Pre-Existing Conditions Handled by Blue Cross of NC?”

  1. Very helpful info. Thanks for posting!

  2. Is pregnency considered preexisting if my wife has not been to the doctor yet? She is about 6 weeks now, but will be about 10 when I have insurance from my current employer?

  3. It really depends on the insurance company. Some will not cover pregnancy if it happens before the insurance is effective. It would be best to ask your current employer’s human resources person.

  4. Does your insurance cover pre-existing through a company group insurance or an individual insurance alone?

  5. Debbie: Pre-existing conditions are covered by both individual plans and group plans. However, you cannot have a gap in coverage from your old plan to the new plan of greater than 63 days.

    Secondly, with group coverage, you have what is called “guaranteed issue”. That means that the insurance will cover you no matter what illness you have.

    With the individual plan, the company may not choose to insure you if you have a serious pre-existing condition.

    Of course, you can be sure that the group insurance plan will cost much more because they will have a greater exposure to losses.

  6. my mom was diagnosed with endiometrosis some years back, but the doctor said to leave it alone for now. she had blue cross back then but then she canceled it for some time. Now she’s been back on the insurance for couple of years and she needs a surgery. will blue cross cover that.

  7. If the pre-existing condition was NOT covered by insurance (treatment was paid for out of pocket by the uninsured) would this also be denied by BC/BS for the one year?

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  9. That means I deal directly with BCBSNC; not through a general agent.