U.S. Department of Labor
Health Benefits Advisor for Employers
Glossary
Hidden Preexisting Condition Exclusion
A plan exclusion which is not designated as a preexisting condition exclusion, but nonetheless satisfies the definition of a preexisting condition exclusion. Examples include a provision that provides coverage for accidental injury only if the injury occurred while covered under the plan; a provision that counts benefits received under prior health coverage against a lifetime limit; and a provision that denies benefits for pregnancy until 12 months after an individual becomes eligible for benefits under the plan.
