Application for waiver of pre-existing waiting period
Application for Waiver of Pre-Existing Waiting Period (PDF)
For individuals 19 years of age and older, individual coverage requires a 180-day pre-existing conditions exclusion period. Please complete this form and
attach you certificate of credible coverage (provided by your employer's previous carrier) and any supporting
documentation(e.g. COBRA letter from employer) so we may determine if you pre-existing
exclusion period can be waived.
