Preexisting Condition

Q: Is it legal to deny an employee health insurance due to a preexisting condition?  

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) places strict limitations on pre-existing condition exclusions for health insurance. Under HIPAA, the only pre-existing conditions that may be excluded under a pre-existing condition exclusion are those for which medical advice, diagnosis, care or treatment was recommended or received within the 6-month period ending on the enrollment date. The exclusion can last no more than 12 months (18 months for late enrollees). The enrollment date is the first day of coverage, or if there is a waiting period, the first day of the waiting period. An employer needs to determine if the savings from maintaining a pre-existing condition is significant enough to justify one.

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