(a) A preexisting condition exclusion in a state plan may not exclude coverage of a preexisting condition unless
(1) the condition first manifested itself within the period of three months immediately before the effective date of coverage in a manner that would cause a reasonably prudent person to seek diagnosis, care, or treatment; or
(2) medical advice or treatment was recommended or received within the period of three months immediately before the effective date of coverage.
(b) A policy may not exclude coverage for a loss due to preexisting conditions for a period greater than six months following the effective date of coverage.
(c) A state plan issued to a person whose previous subscriber contract, health policy, or Medicare supplement policy was involuntarily terminated shall credit the time covered under the previous contract or policy toward an exclusion for preexisting conditions under the state plan if the previous contract or policy had a similar preexisting condition exclusion and the person applies for a state plan within 31 days after termination of the previous contract or policy. If a person covered by this subsection is accepted by the plan administrator and pays a specified premium for retroactive coverage, the state plan is effective retroactively to the date that the person's previous contract or policy terminated.
(d) A state plan issued to a federally defined eligible individual may not impose a preexisting condition exclusion.
(e) A state plan issued to a qualified TAA eligible individual may not impose a preexisting condition exclusion.
Section: Previous 21.55.100 21.55.110 21.55.120 21.55.130 21.55.140 21.55.150 NextLast modified: November 15, 2016