Under the Affordable Care Act, an individual or group health insurer may:
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
The Affordable Care Act prohibits individual and group health insurers from denying coverage or applying preexisting condition exclusions. Before the ACA, insurers commonly imposed waiting periods or exclusions for conditions that existed before the coverage start date. That practice is now banned: a plan may not refuse to cover an illness or injury simply because it was diagnosed or treated before the insured enrolled. This ban applies across all non-grandfathered individual and group market plans, and it works together with guaranteed issue so that coverage cannot be denied or limited based on health history.
Why the other options are wrong
- B) A 12-month preexisting condition exclusion is the old pre-ACA HIPAA standard, which the ACA has replaced with a total prohibition on such exclusions.
- C) A 24-month preexisting condition exclusion was never the standard and is certainly not permitted under the ACA's ban.
- D) The ban on preexisting condition exclusions applies to both individual and group plans, not only to small group plans.
Memory hook
ACA killed preexisting exclusions: no more waiting out your old conditions.