NY Bridge Plan Pre-Existing Conditions

Along with your application you will need to submit proof of your pre-existing condition through one of the following:

• NY Bridge Plan Medical Documentation Form

• Medical records indicating that you have a specified pre-existing condition

• Online medical records that indicate you have one of the listed medical conditions.

List of NY Bridge plan pre-existing conditions:

Brain/Nervous System: Alzheimer’s disease, amyotrophic lateral sclerosis (als), aneurysm, Arnold-Chiari malformation, arteriovenous malformation, ataxia, cerebral palsy, cva /stroke, dementia, demyelinating disease, epilepsy, Guillain-Barré syndrome, Huntington’s chorea, hydrocephalus, mass: diagnosis unknown, multiple sclerosis, muscular dystrophy, myasthenia gravis, myotonia, neurofibromatosis, pain: underlying cause unknown, Parkinson’s disease, Rett’s syndrome, subdural hematoma, tabes dorsalis, Tay-Sachs disease, transient ischemic attack

Cancer/Tumors: anaplastic thyroid carcinoma, basal cell skin cancer, Hodgkin’s disease, leukemia, mass: diagnosis unknown, metastatic, multiple myeloma, neuroblastoma, retinoblastoma, or any other cancer

Congenital Anomalies/Abnormalities: ASD, cleft lip/palate: un-operated/under age 19, cretinism, Dandy-Walker syndrome, heart/lung/kidney/reproductive organ malformation, spina bifida, tetralogy of Fallot

Digestive: ascites, Barrett’s esophageal ulceration, cirrhosis, Crohn’s disease, diseases of the intestines, pancreas, liver or gallbladder, gallstones, hemochromatosis, hepatitis, hernia, Hirschsprung’s disease, mass: diagnosis unknown, pain, significant: underlying cause unknown, polyp: gastrointestinal ulcer, ulcerative colitis, Wilson’s disease

Eyes, Ears, Nose and Throat: : cataracts, cholesteatoma, conditions of the esophagus, corneal degeneration, corneal ulcer, diabetic retinopathy, esotropia, laryngeal papillomatosis, macular degeneration, mass: diagnosis unknown, nasal and paranasal sinus cancers, other esophageal ulceration, pain, significant: underlying cause unknown, otosclerosis, post corneal transplant, sarcoidosis, Sjogren’s syndrome, tonsillitis, tracheotomy present, uveitis

Heart and Circulatory System: anemia; aplastic, hemolytic, auto-immune, thalassemia, Cooley’s or Mediterranean; angina, aneurysm; aortic, abnormal, thoracic, aortic obstruction, aortic valve stenosis, arteriosclerosis, arteritis necrotizing, atrial fibrillation on blood thinners, atrial tachycardia, Behcet’s syndrome, bicuspid aortic valve, bleeding/clotting disorders; i.e. hemophilia, sickle cell, thrombocytopenia, phlebitis, thrombosis, Raynaud’s, bradycardia with pacemaker, cardiac bypass surgery, cardiomyopathy, carotid artery disease, carotid bruit, carotid endarterectomy, congestive heart failure, corpulmonale, coronary artery disease, coronary insufficiency, coronary occlusion, heart attack, heart enlargement, heart murmur, heart valve replacement, hemoglobinuria, hypertension (high blood pressure), hypogammaglobulinemia, ischemic heart disease, Leriche’s syndrome, mitral valve prolapse or stenosis, Osler-Weber-Rendu syndrome, pacemaker, pain, significant: underlying cause unknown, pericarditis, peripheral artery disease, peripheral vascular disease, polyarteritis nodosa, polycythemia vera, pulmonary embolism, pulmonary osteoarthropathy, pulmonic stenosis, rheumatic heart disease, sick sinus syndrome, superior vena cava syndrome, temporal arteritis, trigeminal pulse, ventricular fibrillation or tachycardia, varicose veins, Wegener’s granulomatosis, Wolff-Parkinson-White syndrome

Immune/Lymphatic: Banti’s disease, CVID, immunodeficiency disorder, lymphadema, sarcoidosis

Major Trauma: resulting injuries

Metabolic and Endocrine: acromegaly, Addison’s disease, aids, cystic fibrosis, cytomegalovirus, diabetes, HIV, hyperprolactinaemia, hyperthyroidism, hypothyroidism, lupus, scleroderma, Still’s disease, Turner’s syndrome

Musculoskeletal: amputation/prosthesis, chronic back sprain/strain, connective tissue disease, dermatomyositis, end-stage osteoarthritis with major joint involvement, fasciitis: chronic or recurrent, fibromyalgia, flexion contracture, gout, Marfan’s syndrome, mass: diagnosis unknown, pain, significant: underlying cause unknown, paralysis, paraplegia, Pott’s disease, progeria, psoriatic arthritis, quadriplegia, rheumatoid arthritis, scoliosis/kyphosis, severe arthritis with major joint involvement/joint degeneration, severe disc injury; herniation, bulging, nerve impingement, spinal stenosis with related pain: neck, arms, back, hip, legs, etc., syringomyelia, TMJ

Nervous/Mental/Behavioral: alcohol/chemical dependency, bipolar disorder, depression, eating disorders; anorexia or bulimia, obsessive-compulsive disorder, panic disorders, schizophrenia

Pregnancy/High-Risk Pregnancy/Complications of Pregnancy

Premature Infants (6-month period with no creditable coverage not a requirement for program eligibility)

Reproductive Organs BPH with associated symptoms, mass: diagnosis unknown, uterine fibroids/mass, endometriosis, ovarian cysts, PSA with associated symptoms, PID, HPV, STDs, Peyronie’s disease, prostate stones with prostatitis

Respiratory: asbestosis, asthma, COPD, chronic lung conditions, emphysema, Hamman-Rich syndrome, hyaline membrane disease, laryngeal papillomatosis, pleurisy, pain, significant: underlying cause unknown, pneumocystis carinii, pulmonary fibrosis, sarcoidosis, silicosis (black lung), sleep apnea, status asthmaticus, tuberculosis, upper airway resistance syndrome

Skin: 2nd or 3rd degree burns, cellulitis, eczema, gangrene, herpes zoster, Kaposi’s sarcoma, leprosy, Lyme disease, mass: diagnosis unknown melanoma, nevus: dysplastic syndrome or giant melanocytic, pemphigus, polyp: anal or rectal, psoriasis

Transplants: heart, kidney, liver, lung, other major organs

Urinary: bladder stones, congenital anomalies, interstitial cystitis, kidney disease, kidney stones, mass: diagnosis unknown, nephrectomy, pain, significant: underlying cause unknown, polycystic kidney disease, polyp, bladder: present or recurrent, renal failure, urethral stricture

** If you have a pre-existing medical condition not listed above, you can submit proof of your condition for consideration