Posted by: Dal Watson | July 12, 2010

Prohibition Against Denials Based on Preexisting Conditions under PPACA:

The PPACA prohibits all group health plans and plans offering individual coverage from denying coverage based on an applicants preexisting condition (as currently defined by HIPAA). Previously allowable limited exclusion periods by group health plans that had been in place under HIPAA are no longer applicable. This prohibition generally is effective with respect to plan years beginning on or after January 1, 2014, but for enrollees who are under 19 years of age; this prohibition becomes effective for plan years beginning on or after September 23, 2010.

Final Interim Rule on Prohibition Against Denials Based on Preexisting Conditions:

These interim final regulations prohibits not just an exclusion of coverage of specific benefits associated with a preexisting condition in the case of an enrollee, but a complete exclusion from such plan or coverage, if that exclusion is based on a preexisting condition. These interim final regulations do not change the HIPAA rule that an exclusion of benefits for a condition under a plan or policy is not a preexisting condition exclusion if the exclusion applies regardless of when the condition arose relative to the effective date of coverage.

This is a summary of the Patient Protection and Affordable Care Act. It is intended to provide accurate and authoritative information in regard to the subject matter covered. The accuracy of the information is not guaranteed as is provided with the understanding that we are not rendering legal, accounting, or tax advice.


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