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Application for waiver of the pre-existing condition waiting period

Who is this for?

Michigan Health Insurance – Customer Service – Documents and Forms

If you are have an individual health insurance policy, use this form to apply for a waiver of the pre-existing condition waiting period.

You can use this form if you have an individual health insurance policy and qualify for a waiver of the 180-day waiting period during which pre-existing conditions aren’t covered by your health insurance policy.

What you’ll need:

  • Your enrollee ID card
  • A Certificate of Creditable Coverage from your previous insurance company to show proof of 18 months of continuous health care coverage
  • If applicable, a letter from your employer or COBRA administrator explaining why you weren’t eligible for COBRA coverage
  • If applicable, a letter from your employer-sponsored health plan or COBRA administrator explaining that you’ve exhausted your COBRA coverage
  • A printer to print the form
  • An envelope and postage to mail the form, or a fax machine. Each form includes instructions on where to send it.

How to apply:

  1. Print the Application for Waiver of Pre-Existing Waiting Period (PDF).
  2. Fill out and sign the Application for Waiver of Pre-Existing Waiting Period.
  3. Send us the application and any additional documentation by mail or fax.

Blue Cross Blue Shield of Michigan
600 E. Lafayette Blvd.
Detroit, MI 48226
Mail Code X513

Fax: 1-877-464-3949

For more information, please contact us.

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