1. (a) If major medical insurance coverage is elected during an open enrollment period, the new law benefit recipient and any eligible dependents are subject to a pre-existing condition limitation. Under this limitation, only the first $1,000 of covered medical expenses relating to a pre-existing condition will be paid by the insurer. After a person has been covered for 12 consecutive months, the limitation no longer applies.

2. (b) The pre-existing condition limitation does not apply to

   1. (1) a new law benefit recipient who makes an election of major medical insurance under 2 AAC 39.310(a);
   2. (2) a benefit recipient appointed to a disability benefit;
   3. (3) a new law benefit recipient eligible due to reaching the age of 65; or
   4. (4) an alternate payee.
3. (c) In this section "pre-existing condition" means a condition for which an individual has received diagnosis, tests, or treatment, including the taking of medication, during the three month period before the effective date of coverage.

(Eff. 2/1/93, Register 125)

Authority: AS 14.25.168, AS 22.25.027, AS 39.30.090, AS 14.25.170, AS 22.25.090, AS 39.35.535