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STATE OF MISSISSIPPI (COMPREHENSIVE HEALTH PLAN) v. LISA S. CARPER

MAY 31, 1989

STATE OF MISSISSIPPI (COMPREHENSIVE HEALTH PLAN)
v.
LISA S. CARPER



BEFORE HAWKINS, P.J., PRATHER AND ANDERSON, JJ.

HAWKINS, PRESIDING JUSTICE, FOR THE COURT:

This is an appeal from a judgment rendered in the chancery court of Lafayette County on a claim against the State of Mississippi Comprehensive Health Plan and in favor of Lisa Carper, the insured. We affirm the trial court's judgment, but reverse the award of attorney's fees to the insured.

FACTS

 The State Fiscal Management Board contracted, effective January 1, 1984, with Blue Cross-Blue Shield of Mississippi, Inc., to administer the comprehensive health plan for state employees. Miss. Code Ann. 25-15-1, et seq. This plan is a comprehensive health insurance program providing for payment of medical expenses incurred by covered state employees.

 Article IV of the Plan details the limitations and

 exclusions. In pertinent part it reads:

 ARTICLE IV

 LIMITATIONS AND EXCLUSIONS

 Notwithstanding any other provisions of this Contract, benefits will be limited and conditioned as follows:

 1. No benefits shall be provided hereunder for services or supplies which are provided:

 a. For any pre-existing condition. Pre-existing condition means any ailment, disease, or physical condition which exhibits symptoms at or before the effective date of coverage, regardless of whether the patient knows of the existence or cause of the condition causing abnormal functioning of the body, whether the patient knows the medical explanation for the abnormal functioning, or whether a diagnosis of the condition has been established. No benefits will be provided under this Contract for any pre-existing condition until the patient for whom benefits are sought has had coverage for a period of twelve consecutive months. After twelve consecutive months have elapsed, benefits of this Contract will be provided for Covered Medical Expense for such pre-existing condition. . . .

 Numerous other exclusions follow under this heading including subparagraph (1), which reads:

 1. For congenital conditions, except those of a baby born to a covered Employee or Dependent spouse after the effective date of coverage of such parent.

 On September 14, 1984, Lisa Carper, who had just graduated that year from high school, began employment with the North Mississippi Retardation Center in Oxford, ...


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