Pre-Existing Illnesses Not Covered During Kaiser Accumulation Period

The first 5 years of payment is what we called Accumulation period in Kaiser Long Term Health Care Program. During this period the following sickness is not covered by Kaiser.

For all Pre-existing Illnesses as mentioned below. Planholder shall not be covered during accumulation period. However,  all pre-existing illnesses are covered during the extended period, long-term care period and extended benefit balance period which can be charged to the annual health benefits, total health benefits and annual lifetime healthcare benefits respectively.

Pre-existing Illnesses Not covered during Accumulation Period

  • Acquired Hernias
  • Asthma
  • Arthritis
  • Benign Tumors (ovarian new growth, myoma, cyst, polyps)
  • Bronchial Asthma
  • Buerger’s Disease
  • Cancer (all types)
  • Cardiovascular Disease(Coronary/Valvular/Hypertensive Heart Disease / Cardiomyopathy)
  • Cataracts/Glaucoma
  • Central nervous system lesions (poliomyelitis/Meningitis/ Encephalitis/Neurosurgical conditions)
  • Cerebro-vascular Accident (stroke)
  • Chronic Cholecystitis/Cholelithiasis (gall bladder stones)
  • Chronic Gastrointestinal Tract Disease requiring bowel resection and/or anastomosis
  • Chronic Kidney/Urological disease (Urolithiasis, Obstructive Uropathies, etc.)
  • Chronic Obstructive Pulmonary Disease (Chronic Bronchitis/Emphysema), Restrictive lung disease
  • Collagen diseases (Rheumatoid Arthritis, Systemic Lupus Erythematosus)
  • Diabetes Mellitus and its complications
  • ENT conditions requiring surgery
  • Gastric/duodenal or peptic ulcers
  • Goiter (Hypo/Hyperthyroidism
  • Hemorrhoids and Anal Fistulae
  • Hypertension
  • Liver Parenchyma Disease[Cirrhosis, Hepatitis (except type A), New Growth]
  • Malignancies and Blood Dyscrasias (Cancer, Leukemia, Idiopathic Thrombocytopenic Purpura)
  • Migraine headache
  • Prostate disorders
  • Schistosomiasis
  • Tuberculosis
  • Uterine Myoma, Ovarian cysts, Endometriosis
  • Varicose Veins

(automatic exclusion from waiver benefits)

  • Congenital Disease (all types)
  • Maternity related cases
  • Dermatological care for aesthetic (electrocautery, skin tags, xanthelasma, milia, keloids, scars)
  • Psoriasis / Vitiligo Guillian Barre Syndrome
  • Multiple Sclerosis Demyelinating disease
  • Parkinson’s disease
  • Alzheimer’s Disease
  • Myasthenia Gravis
  • Epilepsy
  • Seizure Disorder
  • Atoimmune Neurological Disease
  • Corrective Eye surgery for myopia / hypermyopia
  • Slip disc
  • Herniated disc
  • Ostesoclerosis
  • Oeteoporosis scoliosis spinal stenosis spondylosis
  • Rehabilitation treatment, physical, speech, occupational and hormonal therapies
  • Infertility or fertility and virility/ potency (erectile dysfunction)
  • Open heart surgeries
  • Angioplasties
  • Valvulaplasties
  • Permanent pacemaker insertion
  • Intra coronary thrombolysis
  • Balloon valvulaplasties
  • Transvenous endocryocardial biopsy
  • Percutaneous intraaortic
  • Balloon pump insertion
  • Balloon atrial septostomy
  • Previous craniotomy sequelae
  • Organ transplantation and complication and other surgeries related to the heart
  • Psychiatric and psychological illnesses including neurotic and psychotic behavior disorders
  • Development disorders
  • Metabolic diseases
  • Sleep and eating disorders
  • Sexually transmitted diseases such as AIDS, Hepatitis B, condyloma, gonorrhea, syphilis, herpes
  • Circumcision, except for correction of Phimosis
  • Diagnosis of unknown etiology or the absence of any organic dysfunction

 

4 thoughts on “Pre-Existing Illnesses Not Covered During Kaiser Accumulation Period

  1. Pingback: What Is Kaiser Long Term Health Care? | IMG (International Marketing Group) - Truly Rich Maker

  2. rubena banug

    1)what is the assurance that after maturity of my long term healthcare, i can get my money putting there? or i can use during the promise of kaiser when it comes to the hospitalization?

    my purpose to ask you this because every time i have prospect this is the one they ask to make them sure, that their money will not lost of value or opportunity.

    2. what if during retirement period then the member go home to their province and kaiser not known their, during hospitalization or check up, etc how can we use? or what is the process of this? then we don’t have money for down payment of the hospital can we inter the hospital or what we do so that the hospital entertain us?
    please give me clarification or instruction that we can help also the other member that needs to know.
    thank you and God bless

    Reply
    1. Dexter Panganiban Post author

      1)what is the assurance that after maturity of my long term healthcare, i can get my money putting there? or i can use during the promise of kaiser when it comes to the hospitalization?

      Response: In my opinion nobody can guarantee that a certain company will still be there during those year, it is the risk that we need to take when getting an insurance. But in Philippines, there are still no insurance that fails to give the benefits of their members. All I can sya is that Kaiser have done a very conservative calculation on their calculation to enable not to fail in the future.

      my purpose to ask you this because every time i have prospect this is the one they ask to make them sure, that their money will not lost of value or opportunity.

      2. what if during retirement period then the member go home to their province and kaiser not known their, during hospitalization or check up, etc how can we use? or what is the process of this? then we don’t have money for down payment of the hospital can we inter the hospital or what we do so that the hospital entertain us?

      At the maturity, Kaiser will give a visa card that can be used anywhere, not only in the Kaiser approved hospital. The Kaiser approved hospital is needed only on the first 5 years or 7 years depending on your plan

      Reply
  3. honeylet

    gud pm! what do you mean by automatic exclusion from waiver benefits? if those pre-existing illness listed under automatic exclusion the patient is not covered or cannot claim anything from KAISER not only in the accumulation period but also in extended period, long-term care period and extended benefit balance period ?

    Reply

Leave a Reply

Your email address will not be published. Required fields are marked *