What are “Pre-Existing Condition Exclusions”?
Under HIPPA, a group health plan or a health insurance issuer offering group health insurance coverage may impose a pre-existing condition exclusion with respect to a participant or beneficiary only if the following requirements are satisfied: • A pre-existing condition exclusion must relate to a condition for which medical advice, diagnosis, care or treatment was recommended or received during the 6-month period prior to an individual’s enrollment date. • A pre-existing condition exclusion may not last for more than 12 months for new or special enrollees, or 18-month for late enrollees, after and individual’s enrollment date. This 12 or 18 month period will be reduced by the n umber of days of the individual’s prior credible coverage, excluding coverage prior to any break in coverage of 63 days or more.
