Pre-existing Condition

ACA-compliant comprehensive plans may not impose them, but limited-benefit policies may still do so — Under the Affordable Care Act, comprehensive individual and group health plans that are ACA-compliant may not impose pre-existing condition exclusions on any enrollee. However, limited benefit policies such as hospital indemnity, specified disease, and other policies sold as excepted benefits are not subject to the same market reforms, so they may still apply pre-existing condition limitations and waiting periods. Agents must understand which products are ACA-compliant comprehensive coverage and which are limited in scope.

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Be reduced by prior creditable coverage the employee had under the old plan — HIPAA's portability rules address the job-lock problem by requiring group plans to credit employees for prior continuous coverage. Creditable coverage, previous employer coverage, COBRA, and other qualifying coverage, reduces any pre-existing condition exclusion by the amount of prior coverage, provided the gap between plans does not exceed the statutory limit. This lets workers change jobs without losing protection. HIPAA is among the federal laws listed in the California A&H objectives affecting group medical plans.

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