When would I be subject to an exclusionary wait period for pre-existing conditions under HIPAA continous creditable coverage, such as a group health plans?

When would I be subject to an exclusionary wait period for pre-existing conditions under HIPAA continous creditable coverage, such as a group health plans?

You may be subject to an exclusionary waiting period for pre-existing conditions if any of the following conditions apply:

  • You are not currently insured but sought medical advice, care, or treatment within the last six months before the effective start date in any given health insurance plan
  • If you were previously insured, but there's been a gap in coverage longer than 63 days
  • You currently are insured, but your current health insurance plan does not qualify as creditable coverage

*Note: Group health plans may not impose a pre-existing condition exclusionary waiting period for pregnancy whether or not the woman had previous health coverage.

In addition, a pre-existing exclusionary wait period may not be applied to newborns, newly adopted children or children placed for adoption under 18, as long as the child was covered within 30 days of the date of birth, adoption or placement for adoption and provided there was no significant break of coverage longer than 63 days.

*This is not applicable to individual health insurance policies.

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