Waiting period regulations for pre-existing conditions have recently changed in Washington State. Effective in 2001 the state mandated that the waiting period for pre-existing coverage would increase from 3 to 9 months. The new regulations directly affect your employees' medical coverage when changing jobs. Knowing the waiting period regulations for pre-existing conditions will help you better administer your group health plan. The new Washington State mandated waiting period of 9 months on pre-existing conditions still remains more generous than the federal HIPAA law requires. HIPAA's regulations for waiting periods on pre-existing conditions limit the exclusion period to a maximum of 12 months. The law defines a pre-existing condition as a mental or physical condition that was present before an individual enrolled in the current plan. Under HIPPA law pregnancy is not considered a pre-existing condition for group plans, and therefore is not subject to the pre-existing clause applying to group coverage. (Pregnancy may be considered a pre-existing condition for individual plans and be subject to the 9-month waiting period). A group insurer may only refuse or limit coverage of a pre-existing condition for which the new enrollee sought medical advice, diagnosis or care, had treatment recommended or received treatment from a licensed or authorized person during the six months immediately prior to his enrollment date to the new plan; also referred to as the "6 month look back rule." Plans and insurers must give an individual "credit" for previous coverage and apply that to the fulfillment of a pre-existing condition exclusion period when an employee changes jobs. For example, an employee was diagnosed with an illness and has maintained coverage for a continuous 5 months. Upon changing jobs, his coverage can be limited or denied for 4 months (in Washington State). At the end of the four-month waiting period, the employee becomes eligible for the same coverage available to all employees. As long as a person maintains continuous coverage with no more than a 63-day gap, no pre-existing condition limit can be imposed. The pre-existing conditions rule protects both the insurance carriers and your employees. It limits adverse selection against the carrier, which helps to control premium costs. Imposing limits on coverage for pre-existing conditions guarantees coverage for employees who change jobs, or have maintained continuous coverage. Source Documents: http://www.hcfa.gov/medicaid/hipaa/content/q&a-emp.asp#10 http://www.afscme.org/pol-leg/kkfact.htm
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