Like virtually all insurance policies, our plan has some limitations on pre-existing conditions.

The specific limitations may vary from state to state, however. So while the following three paragraphs accurately describe the limitations for many states, please consult with the coverage documents for your own state—especially the Certificate of Coverage and the Schedule of Benefits—for the specific language that applies where you live. 

Pre-existing conditions are defined in most Atlas Direct policies as being illnesses or injuries for which, during the 12 months immediately preceding the covered person's coverage effective date: (1) treatment was received or recommended by a doctor, (2) prescription drugs or over the counter medicines were taken, or (3) an ordinarily prudent person would have sought medical care, advice, diagnosis, treatment, or consultation from a doctor.

Given that definition, the pre-existing condition limitation in most Atlas Direct policies states that Atlas Direct will not pay benefits for illnesses or injuries that occur in the first 12 months following a covered person's coverage effective date for any claim that is caused by, contributed to by, or resulting from a pre-existing condition or complications arising from treatment or medications taken for a pre-existing condition.

To summarize, the Atlas Direct insurance product generally has a “12 x 12 rule” for pre-existing conditions: there is a 12-month “pre-enrollment period” that helps to define what counts as a pre-existing condition and a 12-month “exclusion period” after coverage begins during which claims related to pre-existing conditions are not covered.

Please consult with the coverage documents for your own state for the specific language that will apply to you. And please note that Atlas Direct’s insurance plan is not available in all states.