Common use of Preexisting Conditions Clause in Contracts

Preexisting Conditions. Upon the Effective Enrollment Date, Contractor shall assume full responsibility for any Covered Services necessary to treat medical conditions that may have existed prior to an Enrollee’s enrollment with Contractor. Contractor shall support the continuation of any existing treatment plan provided that the Enrollee’s treatment plan is current, a Covered Service, and Medically Necessary. Contractor shall evaluate the appropriateness of integrated Care Management and education for each Enrollee who it determines to have a preexisting condition.