Pre-ex is not waived for members who re-enroll to avoid the higher premium cost of their current supplement plan. A new Emerge number must be assigned so that pre-ex will apply to the new record.

Pre-ex is not waived for Corporate members who switch to a Retail plan. A new Emerge number must be assigned so that pre-ex will apply to the new record.

Pre-ex is not waived for members who have a break in coverage unless premium is paid up to avoid the break. A new Emerge number must be assigned so that pre-ex will apply to the new record.

Pre-ex is not waived when required documentation is not provided to us.

OTHER INFORMATION ON PRE-EX BEING WAIVED:

Waiver of Pre-existing Condition 

1. When a USBA application (or any other application) is processed and waiver of pre-ex is requested, the examiner on Fran’s team will validate the request 

If the validation indicates the applicant is eligible for waiver of pre-ex, then,

1. Rose/claims is notified and Emerge is updated with the waiver indicated (the policy needs to be enrolled with a payment made, such that there is an x-ref number)

What is the notification?  How is Claims notified?  Is it in workflow?  Rose prefers not to use workflow, would prefer email.  Sam to investigate and report back

 A letter is sent to the applicant (the letter is manually produced by the examiner) acknowledging approval of the waiver of pre-ex

Enroll with P05 status, manually added by Enrollment so that it doesn’t go into the pending agent workflow, until we receive validation; 

Need to send letter, and create letter regarding pending of app due to validation of waiver of pre-ex. 

2. If the validation indicates the applicant is NOT eligible for waiver of pre-ex, then,

1. A letter sent to the applicant indicating the decline

3. HTRI records in Inspro do not have the field, or the field is not accessible by the examiners, to indicate waiver of pre-ex.  I put in an IT ticket (#16825) requesting that the field be added or displayed in the HTRI version of the Inspro records.  Too soon to tell if the modification can be made.

Whether this is in Inspro does not impact claims; if pre-ex is waived it is recorded in the notes field in Inspro; if waiver of pre-ex is added post-enrollment by claims, then it is not recorded at all in Inspro

Ron -- Send list of USBA insureds who were supposed to have waiver of pre-ex to Rose so she can check status in Emerge

4. There is a general notes/comments field in Inspro where the waiver could be noted, BUT this field is not available when the enrollment examiner is entering the record.  It would have to be entered after the record is established in Inspro.  This could be a work-around opportunity if the letter is cc’d via email internally to someone who could update the record after enrollment has entered it.  Clearly not ideal though.

If app received with validation, then Andreia enters, it gets A01 status and xref, and app is batched.  After it is processed by Inspro, then Andreia would go back in and add the note and send email to Rose/claims, Rose/claims would add note in Emerge; Andreia then triggers letter to be sent to insured to advise that waiver of pre-ex is approved, letter is imaged but not attached to Inspro record

If app received without validation, then Andreia enters, it gets P05 status, manually added by Enrollment so that it doesn’t go into the pending agent workflow, until we receive validation; Andreia triggers letter regarding pending of app due to validation of waiver of pre-ex (need to create this letter).

If app received and is judged NOT to be eligible for waiver of pre-ex, then policy is issued and letter declining waiver of pre-ex is triggered by Andreia.

CHAMPVA PRE-EX WAIVER 

The effective date of these updated cert is 05/01/2020

Waiver of Pre-existing Conditions Limitation:  The period of time required to satisfy the Pre-Existing Conditions Limitation will be waived for Your spouse  and Your Dependents if:

1)  You enroll for coverage within 63 days of Your retirement date from Active Duty; or 

2)  You enroll for coverage under The Policy within 63 days of enrolling in CHAMPVA.

This rider becomes effective on the latest to occur of:

1. May 1, 2020; 
2. Your Coverage Effective Date; or
3. the first day of the month on or next following the date We accept Your required premium.