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- Health Benefits Advisor for Employers

Determining Compliance with the HIPAA Provisions in Part 7 of ERISA

Limits on Preexisting Condition Exclusions - 12/18-Month Look-Forward Period

Does the plan comply with HIPAA's 12-month (or 18-month) look-forward rule?

The maximum preexisting condition exclusion period is 12 months (18 months for late enrollees), measured from an individual's enrollment date. See ERISA section 701(a)(2); 29 CFR 2590.701-3(a)(2)(ii).

Tip: If the plan has a waiting period, the 12-month (or 18-month) look-forward period must begin on the first day of the waiting period, not the first day of coverage. Therefore, the preexisting condition exclusion period runs concurrently with the waiting period, rather than beginning after the waiting period ends.