Limiting Nevada Health Insurance Coverage Due To Pre-Existing Conditions

Can A Group Health Plan Limit My Coverage For Pre-Existing Conditions?

When you first enroll in a group health plan, the employer or insurance company may ask if you have any pre-existing conditions. Or, if you make a claim during the first year of coverage, the plan may look back to see whether it was for such a condition. If so, it may try to exclude coverage for services related to that condition for a certain length of time. However, federal and state laws protect you by placing limits on these pre-existing condition exclusion periods under group health plans.

• A group health plan can count as pre-existing conditions only those for which you actually received (or were recommended to receive) a diagnosis, treatment or medical advice during the six-month period immediately before you joined that plan. This period is called a look back period.
• Group health plans cannot apply a pre-existing condition exclusion period for pregnancy, newborns, newly adopted children, children placed for adoption, or genetic information.
• Under group health plans, coverage for pre-existing conditions can be excluded for no more than 12 months. However, if you enroll late in your group plan (after you were hired and not during a regular or special enrollment period), you may have a longer pre-existing condition exclusion period of up to 18 months. You will receive credit toward your pre-existing condition period for any previous continuous coverage.
• When you join a new group health plan, the law protects you from a new pre-existing condition exclusion period, provided you maintain continuous creditable coverage. Most types of private and government sponsored health coverage are considered to be creditable coverage. Coverage counts as continuous if it has not been interrupted by a break of 63 or more days in a row.