October 5, 2006 5:44 AM
What Is Pre-Existing Condition Waiting Periods
If you have a gap in coverage of more than 63 days a carrier may impose a "pre-existing condition" waiting period of 9 months for a condition for which medical advice was given, for which a health care provider recommended or provided treatment, or for which a prudent layperson would have sought advise or treatment within 6 months prior to the effective date of the plan. Pre-existing condition waiting periods may not be imposed on pre-natal care although they may be imposed on claims related to birth.
If you have not had a break in coverage of more than 63 days and the plan you held just before you obtained the new coverage was not a "catastrophic plan" and was equivalent to or better than the new plan, the new carrier must credit the time you were enrolled under that plan toward the waiting period for the pre-existing condition. (For example if you had four months coverage, you would still have to wait five months for the new insurance to cover a pre-existing condition.)
If you have 18 months of "creditable coverage" and otherwise qualify as an "eligible individual" under federal law the insurer may not impose a pre-existing condition waiting period on your new coverage.
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