How does HIPAA limit the preexisting conditions that can be excluded from coverage under a preexisting condition exclusion?
Under HIPAA, the only preexisting conditions that may be excluded under a preexisting condition exclusion are those for which medical advice, diagnosis, care or treatment was recommended or received within the 6-month period ending on your enrollment date. Your enrollment date is your first day of coverage, or if there is a waiting period, the first day of your waiting period (typically, your date of hire). If you had a medical condition in the past, but have not received any medical advice, diagnosis, care or treatment for it within the 6 months prior to your enrollment date in the plan, your old condition is not a preexisting condition to which an exclusion can be applied.
Under HIPAA, the only preexisting conditions that may be excluded under a preexisting condition exclusion are those for which medical advice, diagnosis, care or treatment was recommended or received within the 6-month period ending on your enrollment date. Your enrollment date is your first day of coverage, or if there is a waiting period, the first day of your waiting period (typically, your date of hire). If you had a medical condition in the past, but have not received any medical advice, diagnosis, care or treatment for it within the 6 months prior to your enrollment date in the plan, your old condition is not a preexisting condition to which an exclusion can be applied. This 6-month look-back period may be shortened under state law if your coverage is insured through an insurance company or offered through an HMO. Check with your State Insurance Commissioner’s Office to see whether a shorter look-back period applies to you.
Related Questions
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