Limitation on Preexisting Condition Exclusions - 29 U.S.C. § 1181: HIPAA

What this document is

HIPAA - Limitation on Preexisting Condition Exclusions - 29 U.S.C. § 1181 is a state statute published by U.S. Government (Office of the Law Revision Counsel). It is one of the documents that insurance license exam questions are written from, including life & health practice questions. This page summarizes it and points to the official version, which is the text to rely on.

Sections cited in practice questions

Each practice answer shows the exact passage it comes from. These are sections of this document that questions cite, with a short excerpt from the source text.

• 29 U.S.C. § 1181: Subsection (c) (Method of Crediting Coverage)

  “shall count a period of creditable coverage without regard to the specific benefits covered during the period.”

• 29 U.S.C. § 1181: Subsection (f) (Special Enrollment Periods)

  “was not under such a provision and either the coverage was terminated as a result of loss of eligibility for the coverage (including as a result of legal separation, divorce, death, termination of employment, or reduction in the number of hours of employment) or employer contributions toward such...”

• 29 U.S.C. § 1181: subsection (a)(2) (Maximum Preexisting Condition Exclusion Period)

  “(2) such exclusion extends for a period of not more than 12 months (or 18 months in the case of a late enrollee) after the enrollment date;”

• 29 U.S.C. § 1181: subsection (c)(3)(A) (Standard Method of Crediting Coverage)

  “for purposes of applying subsection (a)(3), a group health plan, and a health insurance issuer offering group health insurance coverage, shall count a period of creditable coverage without regard to the specific benefits covered during the period.”

• 29 U.S.C. § 1181(f)(2)(A) (Special enrollment periods; For dependent beneficiaries; In general)

  “If - (i) a group health plan makes coverage available with respect to a dependent of an individual, (ii) the individual is a participant under the plan (or has met any waiting period applicable to becoming a participant under the plan and is eligible to be enrolled under the plan but for a failure...”

• 29 U.S.C. § 1181: Subsection (c)(1) (Creditable coverage defined)

  “Such term does not include coverage consisting solely of coverage of excepted benefits (as defined in section 1191b(c) of this title).”

• 29 U.S.C. § 1181: Subsection (c)(3)(A) (Standard method of crediting)

  “Except as otherwise provided under subparagraph (B), for purposes of applying subsection (a)(3), a group health plan, and a health insurance issuer offering group health insurance coverage, shall count a period of creditable coverage without regard to the specific benefits covered during the period.”

• 29 U.S.C. § 1181: Subsection (f)(2)(C) (Dependent special enrollment; no waiting period)

  “(ii) in the case of a dependent's birth, as of the date of such birth;”

Practice this material

Questions about this source

More Federal sources sources

• Coverage for Pre-existing Conditions (Affordable Care Act) - HealthCare.govFederal guidance
• 20 C.F.R. § 404.1520 -- Evaluation of Disability in General (the five-step sequential evaluation process)Regulation
• Parts of Medicare (Medicare & You / medicare.gov)Federal guidance
• Continuation of Health Coverage (COBRA) - U.S. Department of LaborReference
• Portability of Health Coverage (HIPAA) - U.S. Department of LaborReference
• Fair Credit Reporting Act - 15 U.S.C. § 1681a (Definitions)State statute
• 15 U.S.C. s. 1681b: FCRA permissible purposes of consumer reportsState statute
• 15 U.S.C. s. 1681c: FCRA requirements relating to obsolete information in consumer reportsState statute