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Eberly

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www.kff.org

Another benefit of ACA was it sort of federalized these rules and took the complexity of 50 different states applying their own rules regarding how pre-existing exclusions would be applied.

www.outsourcestrategies.com

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 has put forth a protection measure that insists on limited use of preexisting condition exclusions by a new employer plan.

Preexisting condition exclusions can be applied only to those health conditions for which medical advice, diagnosis, care, or treatment was recommended or received within a 6-month look-back period (6 months before the date on which the individual enrolled into the plan). The first day of the coverage or waiting period (the time period after an employee or a dependent becomes eligible to enroll under the terms specified by the plan) designated in the plan is considered as the enrollment date. This means that if you had a medical condition in the past for which no medical advice, diagnosis, care or treatment has been received within six months prior to your enrollment date in the health plan, it cannot be regarded as a preexisting condition to which an exclusion can be applied.
There are certain cases for which preexisting condition exclusions cannot be applied such as pregnancy (irrespective of the previous coverage the woman had or not) and health conditions of a newborn, an adopted child under age 18 or a child under age 18 placed with a family or individual for adoption (unless the child receives cover under creditable coverage within a period of 30 days since the birth, adoption or placement for adoption and does not undergo a break in coverage). Genetic information may not be considered as a preexisting condition if the diagnosis of a condition is absent.

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