Reference Guide
Benefits, Providers, and Costs
Preexisting Condition Exclusions
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Related Topics
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In the past, many health insurance policies excluded health conditions that had been diagnosed prior to applying for coverage. California’s small group reform law, AB1672, limits preexisting condition exclusions to a six-month “look-back” period (that is, only conditions for which care was recommended or received over the six months prior to the start date of the policy may be excluded) and a six-month exclusion period (that is, exclusion of coverage for these conditions is limited to six months beginning with the start date of the policy). Exclusions are waived for individuals who have had continuous coverage.
The Patient Protection and Affordable Care Act will bring important changes to the individual market in 2014, including eliminating the ability of insurers to deny coverage based on preexisting conditions. Until then, individuals who have a preexisting condition and have been uninsured for 6 months may obtain coverage through a Preexisting Condition Insurance Plan.
For further information on preexisting conditions, see the tool box for “Preexisting Conditions.”
Other documents in the Benefits, Providers, and Costs section:
