Pre-existing condition exclusions
Applies to grandfathered and non-grandfathered group plans (but not grandfathered individual plans)
Requirement overview
- A health plan can't exclude condition-specific benefits because the condition was present before the enrollment date.
- Plans can establish a 30-day open enrollment period during which enrollees under 19 can't be denied coverage.
- Those age 19 and over with pre-existing conditions can't be denied coverage in plans renewing on and after 1/1/2014.
What Priority Health is doing
- Our group plans have never excluded members due to pre-existing conditions.
- Our individual plans have never imposed a pre-existing condition exclusion.
- We will allow individuals under age 19 to enroll throughout the year.
What you need to do
- Fully funded employers don't have to do anything to comply with this requirement.
- Our sales team will work with self-funded groups to:
- Eliminate pre-existing condition exclusions for children under age 19 upon renewal on and after 9/23/2010.
- Remove pre-existing condition exclusions for adults as of 1/1/2014.
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