Can a group health insurance deny an employee or employee’s family coverage for a preexisting condition?
Group health insurance is guaranteed issue in all 50 states, under federal health insurance regulations. This means that no “eligible” employee may be denied coverage due to a pre-existing medical condition. However, an employee may be denied enrollment if they do not meet the eligibility requirements outlined on the contract between the employer and the insurance company. Common reasons for ineligibility are: 1) have not yet met new hire waiting period, 2) do not work the minimum hour requirements, 3) reside outside of the service area of the insurance company, or 4) applying dependents are not immediate family members of the employee. Even though the insurance company can’t deny coverage if all of the eligibility requirements have been met, they can impose a pre-existing condition waiting period if the employee has not had prior and creditable health insurance coverage. The common exclusionary period is 6 months. During this time, the insurance company can deny paying claims on any o
Related Questions
- 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?
- Can a group health insurance deny an employee or employee’s family coverage for a preexisting condition?
