Can you explain how the pre-existing condition in the Long Term Disability contract works?
A 6/6/24 pre-existing condition provision is a limitation, not an exclusion. The limitation applies only to the first 24 months an employee is enrolled in the plan. After 24 months enrolled in the plan, Assurant does not consider any condition, even if it existed prior to the Assurant enrollment, to be considered pre-existing any longer.
A pre-existing condition is a condition for which an employee received medical treatment for, including taking medications or having consultations, in the 6 month period prior to the plans effective date. If a claim were filed for a condition within 24 months of coming onto the plan and the condition received treatment in the 6 months prior to coming onto the plan, that claim would most likely not be payable. (Any non-related condition that did not exist prior to coming on the plan would be covered immediately upon the effective date of the plan.)
Assurant's plans allow for increase in benefits at each annual enrollment if the employee did not take their maximum amount. Any increases in coverage down the road would have a similar pre-existing provision applied to the increase amount of benefit only.
For example, if a $1,000 benefit were elected initially, then 3 years later the employee elected to increase to $1,500 total benefits, the additional $500 in benefit would have a new pre-existing condition limitation. (If a claim were filed at this point, the initial $1,000 would be paid, while the additional $500 maybe not be if a pre-existing condition had existed 6 months prior to the increase of the benefit to $1,500).
