Each individual on the application is assessed separately. As a result, the underwriting decision may include accepted members, declined members and members accepted with a lifetime benefit exclusion. We will proceed with the processing of the application for all members who fall into either of the approved categories with the assumption that the coverage is still desired.
If the application is approved, with or without lifetime benefit exclusion(s), the effective date of enrollment will be listed on the subscriber's coverage notice. Memberships are effective on the date assigned by Anthem. If the entire application is not approved, Anthem will disclose, in writing, the reason(s) for non-acceptance and what needs to be done for reconsideration, if applicable.

If any member is approved with a lifetime benefit exclusion, the amendment will be included in the membership certificate or sent with the letter notifying the member of the lifetime benefit exclusion.

The following waiting period for pre-existing conditions applies to all members –

A pre-existing condition is an injury, sickness or pregnancy, for which the member has, during the 12 consecutive months immediately preceding the member’s original membership effective date, either (1) incurred charges, (2) received medical treatment, (3) consulted a health care professional, or (4) taken prescription drugs. We will not pay for services related to a pre-existing condition for 12 consecutive months after the member’s original membership effective date. I further understand that my coverage will not pay for services unless they are medically necessary as determined by Anthem.

Anthem must receive a 30-day advance notification to cancel your coverage. Anthem has 60 days to process your application.

No person other than the applicant shall alter any written application for any policy without the applicant’s written consent. The exception is that the insurer may make insertions, for administrative purposes only, in such manner as to indicate clearly that such insertions are not ascribed to the applicant.

In no event shall the Company incur any liability before an application is approved or with respect to an application that has been declined. No coverage shall exist under the agreement for which the application is made until approved by the Underwriting Department.