Sedera and Pre-Existing Conditions

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What is Considered a Pre-Existing Condition?

Sedera considers any medical condition that existed prior to membership (diagnosed, suspected or producing observable signs or symptoms) is considered a Pre-existing Medical Condition. Needs that result from Pre-existing Medical Conditions are subject to sharing limitations (as presented in these Guidelines) unless 36 months immediately prior to membership effective date has passed without any signs or symptoms of the condition, without any treatment needed, without any medication prescribed or taken, and without any suspicion by the patient or doctors that the condition is resurfacing. This applies whether or not the cause of the symptoms is unknown or misdiagnosed.

Sedera’s Limitations for Pre-Existing Conditions

Sharing Limitations for Pre-existing Medical Conditions are gradually removed according to the following schedule:

First 12 months – Not shareable
Months 13 – 24 Shareable up to $25,000
Months 25 – 36 Shareable up to $50,000
Month 37 and after – Fully shareable

Source: Sedera Member Guidelines