Under HIPAA, an individual cannot be denied eligibility for benefits or charged more for coverage because of any health factor. A “pre-existing condition,” however, is an illness or condition that is present before an individual's first day of coverage under a group health plan. HIPAA permits- but limits- the ability of a new employer plan to exclude coverage for preexisting conditions.
Under HIPAA, a plan is allowed to look back only 6 months for a condition that was present before the start of coverage in a group health plan. Specifically, the law says that a pre-existing condition exclusion can be imposed on a condition only if medical advice, diagnosis, care, or treatment was recommended or received during the 6 months prior to the enrollment date in the plan.
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