550.1402b Preexisting condition limitation or exclusion; prohibition; exception; “group” defined.
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550.1402b Preexisting condition limitation or exclusion; prohibition; exception; “group” defined.
Sec. 402b.
(1)For an individual covered under a nongroup certificate or under a certificate not covered under subsection (2), a health care corporation may exclude or limit coverage for a condition only if the exclusion or limitation relates to a condition for which medical advice, diagnosis, care, or treatment was recommended or received within 6 months before enrollment and the exclusion or limitation does not extend for more than 6 months after the effective date of the certificate.
(2)A health care corporation shall not exclude or limit coverage for a preexisting condition for an individual covered under a group certificate.
(3)Notwithstanding subsection (1), a health care corporation shall not issue a certificate to a person eligible for nongroup coverage or eligible for a certificate not covered under subsection
(2)that excludes or limits coverage for a preexisting condition or provides a waiting period if all of the following apply:
(a)The person's most recent health coverage prior to applying for coverage with the health care corporation was under a group health plan.
(b)The person was continuously covered prior to the application for coverage with the health care corporation under 1 or more health plans for an aggregate of at least 18 months with no break in coverage that exceeded 62 days.
(c)The person is no longer eligible for group coverage and is not eligible for medicare or medicaid.
(d)The person did not lose eligibility for coverage for failure to pay any required contribution or for an act to defraud a health care corporation, a health insurer, or a health maintenance organization.
(e)If the person was eligible for continuation of health coverage from that group health plan pursuant to the consolidated omnibus budget reconciliation act of 1985, Public Law 99-272, 100 Stat. 82, he or she has elected and exhausted that coverage.
(4)As used in this section, "group" means a group of 2 or more subscribers.
History: Add. 1996, Act 516 , Eff. Oct. 1, 1997 ;-- Am. 1999, Act 7 , Imd. Eff. Mar. 9. 1999
Popular Name: Blue Cross-Blue Shield
Popular Name: Act 350