Bookmark & SharePre-Existing Conditions
Generally, you must wait nine months from the day your coverage begins before Washington Health covers pre-existing conditions, except for maternity care and prescription drugs. The pre-existing condition waiting period does not apply to children up to age 19.
A pre-existing condition is an illness, injury, or condition for which, in the six months immediately preceding a member's effective date of enrollment in Washington Health:
- Treatment, consultation, or a diagnostic test was recommended for or received by the member;
- Medication was prescribed or recommended for the member; or
- Symptoms existed which would ordinarily cause a reasonably prudent individual to seek medical diagnosis, care, or treatment.
If you had coverage similar to Washington Health coverage at any time during the three months just before you applied for or were enrolled in Washington Health, your waiting period for treatment of a pre-existing condition may be waived or shortened.
If you had to wait for Washington Health coverage, you may receive up to three months' credit toward the waiting period. (This does not apply to the waiting period for organ transplant services.)
Waiting Period for Organ Transplant Procedures
You must be enrolled in Washington Health for 12 months in a row before you are covered for an organ transplant, unless:
- The transplant is for a condition that was not pre-existing.
- The transplant is for a child who has had Washington Health coverage since birth.
- The transplant is for a child placed for adoption in the home of a Washington Health member within 60 days of birth and the child is continuously covered by Washington Health from the date of placement, if one or both of the adoptive parents, or family members were enrolled in Washington Health when the child was placed.
The waiting period for coverage of organ transplants will not be waived or reduced because of either:
- Other similar coverage in effect before your Washington Health enrollment, or
- Time spent waiting for Washington Health coverage.
