How does HIPAA limit the pre-existing condition exclusion of group or employer health insurance coverage?
It counts “creditable” health coverage against the pre-existing condition time: Under HIPAA, a group health plan may not impose a pre-existing condition exclusion if the person has had creditable medical coverage for at least 12 months as long as the person had no more than 63 days with no coverage. (Creditable coverage includes most health coverage, such as a group health plan, HMO, individual health insurance policy, Medicaid, or Medicare.) If the coverage was for less than 12 months, the pre-existing exclusion period may be reduced by the number of months of prior creditable coverage. Example: Maria completed her cancer treatment 2 months ago. She had health coverage for the 14 months before she left her job 6 weeks ago, which means she would have 14 months of creditable coverage. The 42 days she went without insurance doesn’t qualify as a “significant break” in coverage. She would have no pre-existing condition exclusion at her new job if she signs up for insurance there, but she m
Related Questions
- I am changing from one type of coverage to another, but staying within the same employers group health plan. Can a pre-existing condition exclusion be applied to my new coverage?
- What defines a pre-existing condition and its coverage in an organizational or institutional group health insurance plan?
- How does HIPAA limit the pre-existing condition exclusion of group or employer health insurance coverage?
