most require prior cred. coverage to eliminate pre x
Pre-existing Come 2014
- Thread starter ctg
- Start date
most require prior cred. coverage to eliminate pre x
- 15,041
Never had that problem with any group I was on. It has been a few years since I was last on a group plan. They only applied the pre-existing if you did not enroll at your earliest opportunity.
Some states have that rule, and yours might. States can add to the Federal rule, but not diminish it.
The Federal rule says that group plans can have a pre-existing condition waiting period of up to 12 months for timely enrollees or 18 months for late enrollees. The waiting period cannot apply to pregnancy or to children ages 18 or under. The maximum look-back period for determining what is pre-ex is 6 months. The exception for creditable coverage is that the group plan must credit your pre-ex waiting period for prior creditable coverage, provided that you did not have a lapse of 63 days or more (not including the time you spent in the new-hire waiting period). You can have multiple prior creditable coverage certificates to be credited against your pre-ex waiting period.
Disclaimer: this is a general summary of the rule, and is not intended to be a detailed description of it, nor is it intended to be legal advice.
- 8,448
Note: I wanted to put this in the EHB thread, but because I was the last one who posted there, the silly forum wouldn't move the thread to the top. So, I'm posting the info/link here...
Blue Cross of Illinois sent out a link today 2-21-2013 for us (brokers) to become familiar with the final EHB rules for this state, or any other state of interest. I see that in Illinois, Surgical "second opinions" and diagnosis will be covered at 100% with no co-pay, deductible, etc.. Yet another expensive burden for insurers.
Go to this website to see the final 2014 itemized Essential Health Benefit listing for your state(s) of interest:
Additional Information on Essential Health Benefits Benchmark Plans | cciio.cms.gov
-AC
Blue Cross of Illinois sent out a link today 2-21-2013 for us (brokers) to become familiar with the final EHB rules for this state, or any other state of interest. I see that in Illinois, Surgical "second opinions" and diagnosis will be covered at 100% with no co-pay, deductible, etc.. Yet another expensive burden for insurers.
Go to this website to see the final 2014 itemized Essential Health Benefit listing for your state(s) of interest:
Additional Information on Essential Health Benefits Benchmark Plans | cciio.cms.gov
-AC
Why would the rates hit them like a ton of bricks? Don't they already have them? By this point, it would seem that they've been tentatively approved.
DC is getting information on rates, who may participate in HIX and who probably won't. This thing isn't playing out as expected.
Next year is mid term elections. Sitting politicians up for re-election will have a target on their backs . . . especially if they supported Alibamacare.
Next year is mid term elections. Sitting politicians up for re-election will have a target on their backs . . . especially if they supported Alibamacare.
At the Hearing before the Senate Finance Committee on 2/14/2013, Mr. Cohen from CCIIO said that HHS would be releasing final regs on EHB's (those regs came out this week, by the way), and then insurance companies can make final design changes to their plans. Then in March and April, insurance companies will send those plans and the rates to the govt for approval, and in July the approvals should be finished.
- Staff
- #29
You have a great point. In states where the Feds are running the exchange, the states gave up rights to approve the plans for the exchange. In partnership states, they kept the right to pick the plans inside the exchanges. However, even in states where the Feds pick the plan for the exchange, the Feds have no rights to control plans outside the exchange. So, DOI will be flooded with filings.
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