We will not reimburse you for insured services or pay an Accidental Death and Dismemberment claim and/or any other expenses directly or indirectly related to:
i) any pre-existing condition if you are covered under the Standard Plan;
ii) any unstable condition if you are covered under the Enhanced Plan,
paid the required premium and if you are age 55 to 85 you have
completed the Medical Declaration.
Pre-existing condition means sickness, illness, disease, symptom, or injury that existed or for which medication has been taken, received,
or prescribed (including prescribed as needed), or for which treatment has been prescribed or received in the
180 days before your effective date of insurance as stated on your policy confirmation.
Unstable condition means a pre-existing condition for which, in the 180 days prior to your effective date of insurance, any of the following apply:
there have been new symptoms or change in symptoms;
existing symptoms have become more frequent or severe;
a physician has found that the medical condition has become worse;
test findings have shown that the medical condition may be getting worse;
a physician has provided, prescribed, or recommended any new medication, or any change in medication;
a physician has provided, prescribed, or recommended new treatment, or any change in treatment;
a physician has provided, prescribed, or recommended any investigative testing, other than regular scheduled maintenance investigations or testing;
there has been hospitalization or referral to a specialist or specialty clinic;
a physician has advised a referral to a specialist or further testing, or there has been testing for which results have not yet been received.
We will not cover any heart condition if, in the 180 days before the effective date, you required any form of nitroglycerine for the relief of angina pain.
We will not cover any lung condition if, in the 180 days before the effective date, you required treatment with prednisone for a lung condition.