Limitations On Pre-Existing Health Condition Exclusions/Waiting Periods
A Pre-Existing Conditions Provision in a health insurance plan excludes coverage for health care due to a condition which exists at the time the policy is issued. The exclusion (also known as a "waiting period") continues for a described period of time that starts running when the policy is issued.
It is very common for a health insurance policy to exclude coverage for existing health conditions during a "pre-existing condition waiting period." If this kind of period applies to you, there will not be any coverage for your existing health condition until the period expires.
There are two time periods to be noted:
- The look back period which is used to identify pre-existing health conditions, and
- The waiting period.
Both of these periods are limited by The Health Insurance Portability and Accountability Act of 1996, generally referred to as "HIPAA". As you read the other sections of this article,keep in mind that HIPAA applies to all employers with 2 or more employees.
If you are starting group coverage with an employer and you have had other health insurance coverage recently, you may avoid a new Pre-Existing Condition Waiting Period because of the time you spent under prior insurance thanks to HIPAA.
For more information, see:
- The Look Back Period
- The Waiting Period
- A Longer Waiting Period For Late Enrollees
- How Can I Learn Whether An Employer's Plan Has A Pre-Existing Condition Waiting Period?
- If There Is A Pre-Existing Condition Exclusion, Does It Mean I Can't File Claims?
NOTE: Because of the Affordable Care Act (*Obamacare"), pre-existing condition exclusions are no longer permitted.