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• HumanaOne
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• Supplemental Medigap Insurance
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Massachusetts Health Insurance Limitations, Waiting Periods & Coverage

What is a pre-existing condition limitation?

This means that the company will not pay for any services for a condition that you had before your effective date if medical advice, diagnosis, care or treatment was recommended or received in the six months before your effective date.

Genetic information does not count as a pre-existing condition if there is no diagnosis of a condition related to that information. Pregnancy is not a pre-existing condition. Trade Act/Health Care Tax Credit-eligible persons can not have a pre-existing condition limit.

What is a waiting period?

This is a period of time immediately after your effective date. During this time the plan won't pay for any services except emergency services.

Trade Act/Health Care Tax Credit-eligible persons cannot have a waiting period.

What is covered in the plans?

A health plan will usually pay for:

• emergency care
• hospital stays and doctor visits
• preventive care
• prescription drugs (sometimes).

All insured health plans must include certain benefits that are mandated by Massachusetts law. You may need to pay for a share of the cost of care through deductibles, coinsurance or co-payments.

There are at least four types of health plans. These types of plans are:

• You are only covered for medical care you get from a network of providers, except in the case of emergency or in case covered benefits are not available from an in-network provider. You may need to pick a "primary care physician" (PCP) from the network who will coordinate all of your care with other providers.
• You are covered for services you get from either an "in-network" provider or an "out-of-network" provider.
• You are insured under two certificates and have both an HMO and an indemnity plan.
• You are covered for services from any covered, licensed providers.