How does crediting for preexisting condition waiting periods work under HIPAA?
A32. Blue Cross uses the “standard method” to credit coverage. The individual receives credit for previous coverage that occurred without a break in coverage of 63 days or more as allowed by the federal law, however, under California law, a 180 day break in coverage is allowed if both the prior and new coverage are employer sponsored. Coverage prior to a break in coverage longer than the allowed break in coverage is not credited against a preexisting condition exclusion period. Blue Cross’ POS plans do not include preexisting condition exclusions. The following does not apply to Blue Cross of California: A plan or issuer may elect the “alternative method” for crediting coverage for all employees. The plan or issuer determines the amount of an individual’s creditable coverage for any of the five specified categories of benefits which are mental health, substance abuse treatment, prescription drugs, dental care and vision care. The standard method is used to determine an individual’s cre
Many plans use the “standard method” to credit coverage. The individual receives credit for previous coverage that occurred without a break in coverage of 63 days or more. Coverage prior to a 63 day break or more is not credited against a preexisting condition exclusion period. A plan or issuer may elect the “alternative method” for crediting coverage for all employees. The plan or issuer determines the amount of an individual’s creditable coverage for any of the five specified categories of benefits which are mental health, substance abuse treatment, prescription drugs, dental care and vision care. The standard method is used to determine an individual’s creditable coverage for benefits other than the five categories that a plan or issuer may use. (The plan or issuer may use some or all of these categories.) With the alternative method, the plan or issuer looks to see is an individual has coverage within a category of benefits (regardless of the specific level of benefits provided wit
Effect of Creditable Coverage If an insured person becomes insured under the policy and was covered under Creditable Coverage for an aggregate period of fewer than 12 months, we will credit the time the insured person was covered under Creditable Coverage in determining whether the Preexisting Condition Provision applies. A period of creditable Coverage will not be credited if, after such period and before the enrollment date, there was a period of 63 consecutive days during all of which the insured person was not covered under Creditable Coverage; however, any waiting period under the policy will not count as a break in the period of Creditable Coverage.
A50. We use the “standard method” to credit coverage. The individual receives credit for previous coverage that occurred without a break in coverage of 63 days or more as allowed by the federal law, however, under California law, a 180 day break in coverage is allowed if both the prior and new coverage are employer sponsored. Coverage prior to a break in coverage longer than the allowed break in coverage is not credited against a preexisting condition exclusion period. The following does not apply to Blue Cross of California and BC Life & Health: a plan or issuer may elect the “alternative method” for crediting coverage for all employees. The plan or issuer determines the amount of an individual’s creditable coverage for any of the five specified categories of benefits which are mental health, substance abuse treatment, prescription drugs, dental care and vision care. The standard method is used to determine an individual’s creditable coverage for benefits other than the five categorie
Many plans use the “standard method” to credit coverage. The individual receives credit for previous coverage that occurred without a break in coverage of 63 days by a new health carrier. Coverage prior to a 63-day break is not credited against a preexisting condition exclusion period by a new carrier. A plan or issuer may elect the “alternative method” for crediting coverage for all employees. The plan or issuer determines the amount of an individual’s creditable coverage for any of the five specified categories of benefits which are mental health, substance abuse treatment, prescription drugs, dental care and vision care. The standard method is used to determine an individual’s creditable coverage for benefits other than the five categories that a plan or issuer may use. (The plan or issuer may use some or all of these categories.) With the alternative method, the plan or issuer looks to see is an individual has coverage within a category of benefits (regardless of the specific level
