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This may not apply, however, if they became ineligible for coverage under the
employer's plan because of a change in their (or their spouse's or parent's) employment
status or because they reached the maximum reimbursement allowable for all benefits
under their employer's plan.
PRESUMPTIVE MEDICAL CONDITIONS APPLICABLE TO THE TRADITIONAL CHIP
POOL (PLANS 2 AND 3)
If you have any of the conditions listed below, you may apply for coverage under Plans
2 or 3 without submitting a rejection notice from an insurance company. A letter from
your physician describing your condition(s) will be required for documentation.
If you have one or more of these conditions, please complete a Section 7 application in
full (be certain to list the condition on Question 14 of the application):
Acquired Immune Deficiency Syndrome
(AIDS) or AIDS Related Complex (ARC)
Angina Pectoris
Arteriosclerosis Obliterans
Cerebrovascular Accident (Stroke)
Chemical Dependency
Cirrhosis of the Liver
Coronary Insufficiency
Coronary Occlusion
Cystic Fibrosis
Friedreich's Ataxia
Hemophilia (Classical)
Hodgkin's Disease
Huntington's Chorea
Juvenile Diabetes
Kidney Failure Requiring Dialysis
Leukemia
Lupus Erythematosus Disseminate
Metastatic Cancer
Multiple or Disseminated Sclerosis
Muscular Atrophy or Dystrophy
Myasthenia Gravis
Myotonia
Paraplegia or Quadriplegia
Parkinson's Disease
Poliomyelitis
Polycystic Kidney
Severe Traumatic Brain Injury
Sickle Cell Anemia
Silicosis Pneumoconiosis (Black Lung)
Syringomyelia
Wilson's Disease
