Blue Cross Blue Shield of Texas

Pre-Existing Condition Exclusions

Pre-existing Conditions are those health conditions which were diagnosed or treated by a provider during the 12 months prior to the coverage effective date, or for which symptoms existed which would cause an ordinarily prudent person to seek diagnosis or treatment.
Any Pre-existing Condition will be subject to a waiting period of 365 days.

Exception for Prior BCBSTX Group Plan Coverage

For applicants with continuous prior coverage (no more than a 31 day gap) under a Blue Cross and Blue Shield of Texas employer-sponsored plan,
Blue Cross and Blue Shield of Texas provides credit against the individual plan pre-existing condition exclusion waiting period.

For example, if you enroll in a Blue Cross and Blue Shield of Texas “individual” plan after being continuously covered for 6 months under a Blue Cross and Blue Shield of Texas employer group health plan, you’ll be considered to have satisfied 6 months of the 12 month pre-existing condition exclusion waiting period.

This exception works for maternity as well. If you were insured under an employer’s BCBSTX group health plan for a year or more, and you immediately enroll in a BCBSTX individual plan with the maternity option, you’ll have no waiting period for the maternity benefits.

Medical Condition-Specific Waivers

If you have a condition, illness, or injury that can be identified as one that does not necessarily affect your overall good health but could affect the risk balance of all insureds, Blue Cross and Blue Shield of Texas may exclude that condition from coverage.
This means that expenses for treatment of that condition or any other condition related to it will not be covered for a specified period of time.

Blue Cross and Blue Shield of Texas will place a maximum of two coverage exclusion riders on any one applicant.
When a policy is conditionally approved with one or two exclusion riders, coverage will not be put in force until the applicant has accepted the offer by signing, dating, and returning the rider along with any other outstanding requirements that may be applicable.

Mental Health Counseling Guidelines

BCBSTX is extremely strict (and in our opinion, often unfair) on how they underwrite individuals whom have had mental health counseling. Individuals currently in counseling with a licensed therapist or psychologist will be automatically declined, regardless of the reason they are in counseling.
BCBSTX will only consider accepting an individual after they have completed their treatment for at least 6 months, and acceptance will be based on the original diagnosis/reason for treatment. For example, an individual completing marriage counseling would most likely be accepted while an individual completing counseling for a drug addiction would not.

Medical Condition Rejection List

If you have a condition, illness, or injury that is listed on the Medical Condition Rejection List below, you will most likely be declined for individual coverage with Blue Cross Blue Shield of Texas.

These conditions include, but are not limited to: