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Limitations On Pre-Existing Health Condition Exclusions/Waiting Periods

The Waiting Period

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Once the Look Back Period determines which conditions are Pre-Existing, the Waiting Period is the period of time you must wait to have coverage for the Pre-Existing Condition. Under HIPAA, the Waiting Period cannot exceed twelve months (365 days) if you sign up for the health coverage as soon as you are permitted to by the employer.

Two examples:

Example 1. Kate, the person in Example 1 in The Look Back Period section above, will have coverage for diabetes on July 1, 2011 twelve months after her effective date of coverage.

Example 2. Tom, the person in Example 2 above: If Tom is found to have cancer in August, 2010, he will have coverage for it since cancer is not a Pre-Existing Condition according to the contract.

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