Special Coverage for “Grandfathered Diabetic Group Clause Samples

The "Special Coverage for Grandfathered Diabetic Group" clause establishes specific health insurance benefits for individuals with diabetes who were previously covered under an older or existing plan before new regulations or plan changes took effect. This clause typically ensures that these individuals continue to receive certain diabetes-related benefits, such as coverage for insulin, testing supplies, or diabetes education, under the terms that existed prior to any plan modifications. Its core function is to protect the rights and coverage of long-standing members, preventing them from losing essential benefits due to changes in policy or law.
Special Coverage for “Grandfathered Diabetic Group. For insulin dependent diabetics who have been continuously enrolled for health coverage insured or administered by Blue Cross Blue Shield through the SEGIP since January 1, 1991 and who were identified as having used these supplies during the period January 1, 1991 through September 30, 1991 (herein the “Grandfathered Diabetic Group”), diabetic supplies are covered as follows: • Test tapes and syringes are covered at one hundred (100) percent for the greater of a thirty (30) day supply or one hundred (100) units when purchased with insulin.
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Related to Special Coverage for “Grandfathered Diabetic Group

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