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Group Health Plan Regulations for Pre-Existing Conditions

Sometimes a health insurance provider will try and evaluate you separately under a group plan to determine if you have a pre-existing condition. Even if they accept you for coverage, often they will look into your health history when you seek treatment for a condition. They may try and impose an exclusion period or charge more for your coverage upon finding a pre-existing condition. Nevada state and federal laws offer you some protection from this happening.

The insurance provider can only apply an exclusion period for those that received a diagnosis, treatment or medical advice for a condition within the six months prior to enrollment for the health insurance. This is called a look back period.

Although there is a look back period in relation to illness within the last six months, the insurance provider cannot label pregnancy, adoption, newborns or genetic information a pre-existing conditions. Pre-existing conditions are only health problems that have been treated or diagnosed, not additional dependents or genetic information that may cause alarm for potential illness.

The state and federal laws put limitations on exclusion periods. This is good, because even if you are not covered for a while, you cannot be denied coverage for more than a year. The exclusion period limitation is 12 months unless you enrolled for the group plan late. If you enrolled late, the exclusion period limitation is 18 months. If you have continuous coverage from an old plan, that may be credited toward your new coverage while an exclusion period is in effect. If you have obtained COBRA coverage, this is when it can be used.

When you change jobs, you cannot be evaluated for a pre-existing condition. This is provided that you have continuous coverage on your old plan. If you are provided continuous coverage, it can be credited towards the new coverage and therefore cannot allow an exclusion period, since you were already evaluated for pre-existing conditions in the previous group plan.