How does crediting for pre-existing exclusions waiting periods work under HIPAA?
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 acategory of benefits (regardless of the specific level of benefits provided with
