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42 U.S. Code § 300gg-3. Prohibition of preexisting condition exclusions or other discrimination based on health status
(a) In general
A group health plan and a health insurance issuer offering group or individual health insurance coverage may not impose any preexisting condition exclusion with respect to such plan or coverage.
(b) DefinitionsFor purposes of this part—
(1) Preexisting condition exclusion
(A) In general
The term “preexisting condition exclusion” means, with respect to coverage, a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the date of enrollment for such coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before such date.
(B) Treatment of genetic information
Genetic information shall not be treated as a condition described in subsection (a)(1) [1] in the absence of a diagnosis of the condition related to such information.
(2) Enrollment date
The term “enrollment date” means, with respect to an individual covered under a group health plan or health insurance coverage, the date of enrollment of the individual in the plan or coverage or, if earlier, the first day of the waiting period for such enrollment.
(3) Late enrolleeThe term “late enrollee” means, with respect to coverage under a group health plan, a participant or beneficiary who enrolls under the plan other than during—
(A)
the first period in which the individual is eligible to enroll under the plan, or
(B)
a special enrollment period under subsection (f).
(4) Waiting period
The term “waiting period” means, with respect to a group health plan and an individual who is a potential participant or beneficiary in the plan, the period that must pass with respect to the individual before the individual is eligible to be covered for benefits under the terms of the plan.
(c) Rules relating to crediting previous coverage
(1) “Creditable coverage” definedFor purposes of this subchapter, the term “creditable coverage” means, with respect to an individual, coverage of the individual under any of the following:
(A)
A group health plan.
(B)
Health insurance coverage.
(C)
Part A or part B of title XVIII of the Social Security Act [42 U.S.C. 1395c et seq., 1395j et seq.].
(D)
Title XIX of the Social Security Act [42 U.S.C. 1396 et seq.], other than coverage consisting solely of benefits under section 1928 [42 U.S.C. 1396s].
(E)
Chapter 55 of title 10.
(F)
A medical care program of the Indian Health Service or of a tribal organization.
(G)
A State health benefits risk pool.
(H)
A health plan offered under chapter 89 of title 5.
(I)
A public health plan (as defined in regulations).
(J)
A health benefit plan under section 2504(e) of title 22.
Such term does not include coverage consisting solely of coverage of excepted benefits (as defined in section 300gg–91(c) of this title).