| There is generally confusion when talking about group | | | | normally called the 'look back' period. |
| health insurance schemes because, although many | | | | If a pre-existing condition exclusion period is imposed |
| people say that group insurance plans may not | | | | it may not usually be longer than 12 months and you |
| refuse you cover because of your current health or | | | | must be credited for any previous continuous |
| your medical history, others maintain that they are | | | | creditable coverage. In this case cover is said to be |
| permitted to refuse cover for pre-existing medical | | | | continuous if it is not interrupted by a break of more |
| conditions. | | | | than 63 days in a row. Almost all government |
| The reality is that you may not be denied | | | | sponsored and private health coverage is considered |
| membership of a group insurance plan solely because | | | | to be creditable and this will include such things as |
| of you current medical state, including any disability | | | | Medicare, Medicaid, student health insurance, military |
| which you may have, or because of your previous | | | | health coverage, VA coverage, Indian health |
| medical history. | | | | insurance, individual health insurance, foreign national |
| But, both insurance companies and employers are | | | | coverage and much more. |
| entitled to question you about any pre-existing | | | | If an employer requires a waiting period for individuals |
| medical conditions at the time of enrollment or, if you | | | | to enter a plan, or an HMO requires a similar affiliation |
| submit a claim in the first year of cover, to look back | | | | period, these may not be counted in determining any |
| to see if you have any prior history of the condition | | | | break in continuous coverage. Further, pre-existing |
| which gives rise to the claim. | | | | condition exclusion periods must take into account |
| When a pre-existing condition is reported or found | | | | the waiting or affiliation period with the exclusion |
| the insurer or employer may not simply deny you | | | | period beginning on the same day as the waiting or |
| cover under a group plan but is permitted to impose | | | | affiliation period. |
| an exclusion period for cover of that particular | | | | When moving from one group plan to another then |
| pre-existing condition. This said, there are both | | | | the administrator of the new scheme is permitted to |
| federal and state laws which limit the exclusions | | | | examine your previous plan in order to work out any |
| which insurance companies and employers are | | | | credit towards a pre-existing condition exclusion |
| permitted to place on their group schemes. | | | | period for your new plan. This may mean for instance |
| Group health insurance schemes are not allowed to | | | | that if the new plan offers cover which was not |
| apply pre-existing condition exclusions as a result of | | | | provided under the old plan then exclusion periods |
| pregnancy or genetic information. Additionally, | | | | can be imposed for pre-existing conditions which |
| exclusions are not allowed for newborns, newly | | | | were not previously covered but which are covered |
| adopted children and children who are placed for | | | | under the new plan. |
| adoption. | | | | One more point to note is that you must be given |
| Generally speaking, pre-existing condition exclusions | | | | appropriate written notice of any exclusion period |
| can only be imposed for conditions which are | | | | and the group plan administrator has to help you to |
| diagnosed within the 6 months prior to joining a | | | | obtain a certificate of creditable coverage from your |
| group scheme for which you have received (or been | | | | previous plan if you wish him to do so. |
| recommended to have) treatment. This period is | | | | |