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)
Cerebrovascular Accident (Stroke)
Cirrhosis of the Liver
Kidney Failure Requiring Dialysis
Lupus Erythematosus Disseminate
Multiple or Disseminated Sclerosis
Muscular Atrophy or Dystrophy
Paraplegia or Quadriplegia
Severe Traumatic Brain Injury
Sickle Cell Anemia
Silicosis Pneumoconiosis (Black Lung)
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