(Cont’d) individual's preexisting health conditions. Plan may not include a waiting period for benefits or enrollment due to a preexisting condition. Preexisting 45 CFR 148.180 Plan may not impose any preexisting condition exclusion on the Conditions (d)(1) of genetic information. (Cont’d) 42 U.S.C. Issuer cannot apply any waiting period longer than 90 days. §300gg-7 Resources: 42 U.S.C. Plan must correctly define “Preexisting Condition”. §300gg- The term “preexisting condition exclusion” means, with respect to coverage, a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the date of enrollment for such coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before such date. 42 U.S.C. Genetic information may not be treated as a preexisting condition in the absence of a diagnosis of the condition related to the information. Organ 42 USC The plan may not include a waiting period for organ transplant benefits Transplant §300gg-3(a) because such a waiting period excludes, for the waiting period, benefits Waiting WAC specifically relating to conditions requiring transplants. Period 42 Special U.S.C. Plan can use open enrollment periods but must offer Special §300gg-1(b)(1); Enrollment Enrollment where required. 45 CFR 147.104(3). Periods – 45 C.F.R. Plan must offer enrollment to eligible persons regardless of open Federal law enrollment requirements (“special enrollment”), in the following
(Cont’d) Preexisting Conditions (Cont’d) individual's preexisting health conditions. Plan may not include a waiting period for benefits or enrollment due to a preexisting condition. 45 CFR 148.180 (d)(1) Plan may not impose any preexisting condition exclusion on the of genetic information. 42 U.S.C. §300gg-7 Issuer cannot apply any waiting period longer than 90 days. Resources: 42 U.S.C. Plan must correctly define “Preexisting Condition”. The term “preexisting condition exclusion” means, with respect to coverage, a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the date of enrollment for such coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before such date. 42 U.S.C. Genetic information may not be treated as a preexisting condition in the absence of a diagnosis of the condition related to the information. Organ Transplant Waiting Period 42 USC §300gg-3(a) WAC The plan may not include a waiting period for organ transplant benefits because such a waiting period excludes, for the waiting period, benefits specifically relating to conditions requiring transplants. Special Enrollment Periods – Federal law 42 U.S.C. §300gg-1(b)(1); Plan can use open enrollment periods but must offer Special Enrollment where required. 45 CFR 147.104(3). 45 C.F.R. Plan must offer enrollment to eligible persons regardless of open enrollment requirements (“special enrollment”), in the following §300gg-
checklist-forms-2018-hcsc-small-group-analyst-checklist.docx