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