Under HIPAA's portability rules as modified by the ACA, which statement is correct regarding pre-existing condition exclusions in group health plans?
Explanation
Originally, HIPAA Title I (29 U.S.C. §1181) permitted group health plans to impose a pre-existing condition exclusion of up to 12 months (18 months for late enrollees), reduced by prior 'creditable coverage' under a HIPAA certificate. However, the Affordable Care Act effectively eliminated pre-existing condition exclusions: §2704 of the Public Health Service Act, added by the ACA, prohibits ANY pre-existing condition exclusion in non-grandfathered individual and group health plans. Options A and B describe the pre-ACA HIPAA rule, which has been superseded. Option D is fabricated. Today, both Covered California and employer group plans must accept enrollees regardless of pre-existing conditions; California Insurance Code §10198.7 mirrors this protection at the state level.
Law Reference: 29 U.S.C. §1181 (HIPAA Title I portability)Practice all 315 questions free — no signup required.
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