Under HIPAA, a plan is allowed to look back only 6 months for a condition that was present before the start of coverage in a group health plan.
Specifically, the law is that a preexisting condition exclusion can be imposed on a condition only if medical advice, diagnosis, care, or treatment was recommended or received during the 6 months prior to your enrollment date in the plan.
You can reduce or eliminate the maximum preexisting condition exclusion period if you can show "creditable coverage." Most health coverage can be used as creditable coverage, including participation in a group health plan, COBRA continuation coverage, Medicare and Medicaid, as well as coverage through an individual health insurance policy.
However, you should try to avoid a 63 day (significant break) in coverage if you want to be able to count your previous coverage. If you have a break shorter than 63 days, coverage you had before that break is creditable coverage and can be used to offset a preexisting condition exclusion period.
Days spent during a waiting period for health insurance coverage cannot be used as credit, but are also not counted toward the significant break (63 days) you are trying to shorten.
Craig Casey is an Writer, Coach, Blogger, Husband, and Former Health Insurance Agent helping people on the web since 1999 with their health insurance problems.
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