I changed jobs and my new group health plan imposes a pre-existing condition exclusion period. How does my new plan decide how long my pre-existing condition exclusion period will be under HIPAA?
The maximum length of a pre-existing condition exclusion period is 12 months after the enrollment date, or 18 months in the case of a “late enrollee.” (A late enrollee is a person who enrolls in a plan after the earliest date on which coverage can become effective under the terms of the plan. If you enroll during an open enrollment period or due to a family change, you are not considered a late enrollee.) This 12- or 18-month period may be shorter under some state laws 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 your exclusion period might be shorter. A plan must shorten a person’s pre-existing condition exclusion period by the number of days the person had creditable coverage. But if you were without coverage for 63 days or more (called a “significant break in coverage”), HIPAA does not require the new insurance plan to count any days of creditable coverage that came before the
Related Questions
- I changed jobs and my new group health plan imposes a pre-existing condition exclusion period. How does my new plan decide how long my pre-existing condition exclusion period will be under HIPAA?
- I changed employment and my new group health plan imposes a preexisting condition exclusion period. How does my new plan determine the length of my preexisting condition exclusion period?
- 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?
