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Ask the Health Insurance Expert

I had health insurance through a former employer, but when I changed jobs, my new employer required a three-month waiting period before I qualified for the health plan. I was diagnosed with an illness a few days before the new coverage went into effect. Will this count as a pre-existing condition?

It depends on whether you maintained coverage during the waiting period. Under the landmark Health Insurance Portability and Accountability Act (HIPAA), your new employer cannot exclude a pre-existing condition from coverage if you maintained health insurance for the last 12 months without a break of 63 consecutive days or more.

After you left your other job, did you continue health insurance coverage through COBRA or buy individual health insurance? Either would count as coverage.

The Consolidated Omnibus Reconciliation Act (COBRA), another landmark federal law, lets people continue to receive coverage through an employer-sponsored health plan after loss of a job, death or divorce. You have to pay the full premium for COBRA, but you have the security of continued coverage.

What if you did not maintain health insurance coverage?

If you didn't continue or buy new coverage for that three-month gap, your employer can exclude your illness as a pre-existing condition for up to 12 months. However, there is an important exception: pregnancy. Employer-sponsored health plans that include maternity coverage cannot exclude pregnancy as a pre-existing condition, period.

Talk to a health plan representative to discuss your situation. One possibility, if you can't qualify for coverage of a pre-existing condition, is to seek insurance through the federal Pre-Existing Condition Insurance Plan. The plan, made available by the Affordable Care Act, is offered in every state and is geared to people who can't qualify for health insurance because of a medical condition. You can find more information about the health plan through U.S. Department of Health and Human Services website.

For more, see HIPAA: Your rights to health insurance portability and Pre-Existing Condition Insurance Plans available.

Last updated: Aug. 11, 2011