How Are Pre-existing Conditions Addressed Under The Health Insurance Portability and Accountability Act?
Within the Act, the concept of “creditable coverage” is introduced. In essence, individuals who have had insurance coverage (including Medicaid) are given “credit” for this coverage. Traditionally, employers have implemented an exclusion or limitation period on new hires with a pre-existing condition. The Act changes this practice by allowing employees to apply prior creditable coverage against their exclusion or waiting period, thus greatly reducing and in some cases eliminating an exclusion or waiting period. If you move from one group plan to another group plan, the new group plan must reduce any exclusion or waiting period based on a preexisting condition by one month for every month that you had creditable coverage under a previous plan, provided that you enroll when first eligible and had no break in previous coverage greater than 62 days. Once a 12-month limitation period is met, no new limitation may ever be imposed on you as long as you maintain continuous coverage, even if yo
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