Section 420-G:7 Preexisting Condition Exclusion Periods.
I. A health carrier providing health coverage to large employers may impose a preexisting condition exclusion period, but only if it is at least as favorable to covered persons as the following:
(a) No preexisting condition exclusion shall extend beyond a period of 9 consecutive months after the date of enrollment of the person's health coverage; and
(b) Such preexisting condition exclusion period may only apply to a condition, whether physical or mental, regardless of the cause of the condition, for which medical advice, diagnosis, care or treatment was recommended or received during the 3 months immediately preceding the enrollment date of health coverage.
II. A health carrier providing health coverage to individuals or small employers may impose a preexisting condition exclusion period, but only if it is at least as favorable to covered persons as the following:
(a) No preexisting condition exclusion period shall extend beyond a period of 9 consecutive months after the date of enrollment of the person's health coverage.
(b) Such preexisting condition exclusion period may only apply to a condition, whether physical or mental, regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was received or recommended during the 3 months immediately preceding the date of enrollment of the person's health coverage.
III. In applying a preexisting condition exclusion period, a health carrier shall credit the time the person was covered under previous health coverage subject to the following:
(a) A period of otherwise creditable coverage shall not be counted if, after such period and before the enrollment date or application date of new health coverage, there was a 63-day period during all of which the person was not covered under any creditable coverage; except that
(b) Any length of time that a person is in an employer imposed waiting period for health coverage shall not be counted toward the 63-day period described above; and
(c) If a person did not have health coverage during a period of unemployment prior to the effective date of new employer-based group health coverage, the lack of health coverage during the period of unemployment shall be disregarded and, for the purposes of crediting coverage, coverage shall be considered to have been continuous from the date of termination of the person's health coverage immediately prior to the period of unemployment to the effective date of the new employer-based group health coverage.
IV. Health carriers providing health coverage in the large employer market may use the alternative method of crediting coverage as specified in rules.
V. Health carriers shall provide written certification of the period of creditable coverage which accumulated while a person was under the health coverage plan, and shall also state any waiting period which was imposed prior to receiving health coverage.
(a) The written certification shall be provided at the time a person ceases to be covered under a health coverage plan, and on a request made on behalf of the person made not later than 24 months after the date of the cessation of coverage.
(b) A health carrier, which elects to credit coverage under the method set forth in rules pursuant to paragraph IV that enrolls a person with a certificate of creditable coverage, may request of the entity that issued the certificate the additional information required under the rules. The issuing entity shall promptly disclose such information to the health carrier, but may charge the reasonable costs of disclosing such information.
VI. A health carrier providing health coverage to large or small employer groups shall not:
(a) Treat genetic information as a condition subject to a preexisting condition exclusion period in the absence of a diagnosis of the condition related to such information.
(b) Impose any preexisting condition exclusion relating to pregnancy as a preexisting condition.
(c) (1) Subject to subparagraph (3), impose any preexisting condition exclusion in the case of a newborn who, as of the last day of the 30-day period beginning with the date of birth, is covered under creditable coverage.
(2) Subject to subparagraph (3), impose any preexisting condition exclusion in the case of a child who is adopted or placed for adoption before attaining 18 years of age and who, as of the last day of the 30-day period beginning on the date of the adoption or placement for adoption, is covered under creditable coverage. The previous sentence shall not apply to health coverage before the date of such adoption or placement for adoption.
(3) Subparagraphs (1) and (2) shall no longer apply to the person after the end of the first 63-day period during all of which the person was not covered under any creditable coverage.
Source. 1997, 344:1. 2003, 188:11, 12, eff. Jan. 1, 2004. 2007, 289:23, eff. Jan. 1, 2008.