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?
It depends on how long you have been in the group health plan. If you sign up at the first opportunity, a pre-existing condition exclusion cannot extend more than 12 months after your enrollment date. Your enrollment date is the first day on which you are able to receive benefits under a group health plan or, if your plan imposes a waiting period, the enrollment date is the first day of your waiting period – typically your date of hire. If less than 12 months have passed, a pre-existing condition exclusion might be applied, but the exclusion cannot last beyond the one-year anniversary of your enrollment date (a total of 12 months). See below for examples of exclusions in several situations.
Related Questions
- My employer has a "waiting period" for enrollment in the health plan. Does this change the pre-existing condition exclusion period under HIPAA?
- How does changing jobs with a pre-existing condition affect my eligibility for association-affiliated group health coverage?
- Can an employer or group choose not to offer coverage to qualified dependents through their health plan?
