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 - Pregnancy
Does the plan comply with HIPAA by not imposing a preexisting condition exclusion on pregnancy?
A plan may not impose a preexisting condition exclusion relating to pregnancy. See ERISA section 701(d)(3); 29 CFR 2590.701-3(b)(5).
Tip: A plan provision that denies benefits for pregnancy until 12 months after an individual generally becomes eligible for benefits under the plan is a preexisting condition exclusion and is prohibited. See 29 CFR 2590.701-3(a)(1)(ii) Example 5.
