Regulations on Preexisting Condition Exclusions

Currently, preexisting conditions can affect individuals covered by group health plans, as well as the plans themselves. Carriers may deny certain people coverage, increase the premiums for the group contract, or decline to write the group, subject to applicable state law. Plans, including larger self-funded plans, may examine large claims, investigate whether those claims relate to a preexisting condition, and deny coverage after-the-fact on that basis. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) attempted to mitigate the impact of these plan provisions by providing credit for prior creditable coverage, thus reducing or eliminating the exclusion period, but the law did not protect everyone fully. 

On June 28, 2010, the Departments of Labor, Treasury (IRS), and Health and Human Services jointly published interim final regulations on preexisting condition exclusions. The regulations also addressed several other issues regarding health reform (to be addressed in separate Hub Client Bulletins).

Download the Health Reform Regulations on Preexisting Condition Exclusions Client Bulletin to learn more about the impact of preexisting condition exclusions and provide some action items for employers.