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How can we avoid a pre-exisiting condition exclusion if this waiting period is longer than the 63-day lapse in coverage allowed under the federal HIPAA law?

Aug. 13, 2007

Question:
My husband is switching jobs and will not be eligible for his new group health plan for 90 days. We have had continuous group coverage for the past 10 years. How can we avoid a pre-exisiting condition exclusion if this waiting period is longer than the 63-day lapse in coverage allowed under the federal HIPAA law? I have a potential health problem and I'm scared of losing my HIPAA eligibility.

Eileen, Pennsylvania

Answer:
Dear Eileen,

HIPAA does not count that waiting period as a lapse in health coverage. You will not be penalized under HIPAA for exceeding the 63-day window.

The federal HIPAA law imposes limits on the extent to which some group health plans can exclude coverage for pre-existing conditions. For instance, if you've had "creditable" health insurance for 12 straight months (with no lapse in coverage of 63 days or more) and you switch to a new group health plan, the new plan cannot invoke a pre-existing condition exclusion. It must cover your medical problems as soon as your new plan begins. Read HIPAA: Your rights to health insurance portability.

While you will not lose your HIPAA eligibility in this situation, you will be without health insurance for 90 days. If your husband's former company offers COBRA, you may want to consider continuing your former plan until the new one kicks in. See Know your COBRA rights.

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Disclaimer: We are journalists, not financial planners or insurance brokers. Nothing we say should be interpreted as a recommendation to buy or sell any insurance product, or to provide other financial or legal advice.

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