Human Resources

State Health Plan/Preexisting Cond Waiting Periods

The State of NC Teachers' & State Employees' Comprehensive Major Medical Plan imposes a preexisting condition waiting period for late enrollees as defined by NCGS 135-40.3(b)(2). A late enrolee that has a medical cond. before coming to the Plan may have to wait a certian period of time before the Plan will provide coverage for that cond. This waiting period applies only to cond. for which medical advice, diagnosis, care or treatment was recommended or received within six months PRIOR to the effective date of coverage. The preexisting condition-wating period does NOT apply to pregnancy or to a child who is enrolled in the plan within 30 days after birth, adoption or the commencement of a foster child relationship. This waiting period may last up to 12 months from the first day of coverage. However, you can reduce the length of this waiting period by the number of days of prior creditable coverage. Most prior health coverage is creditable and can be used to reduced the preexisting condition-waiting period if there is no beak in coverage of more than 63 days. Please call 1-800-422-4658 if you have any questions on preexisting condition waiting periods and creditable coverage.

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