U.S. Department of Labor
Health Benefits Advisor for Employers
Determining Compliance with the HIPAA Provisions in Part 7 of ERISA
Limits on Preexisting Condition Exclusions - Newborns
Does the plan comply with HIPAA by not imposing an impermissible preexisting condition exclusion on newborns?
A plan generally may not impose a preexisting condition exclusion on a child who enrolls in creditable coverage within 30 days of birth. See ERISA section 701(d)(1); 29 CFR 2590.701-3(b)(1).
Tip: Even if a child is not covered under the plan within 30 days of birth, the child still cannot be subject to a preexisting condition exclusion if he or she was enrolled in any creditable coverage within 30 days of birth and does not incur a subsequent 63-day break in coverage.
