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Health Benefits Advisor for Employers


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.


Complete Glossary of Terms