110 STAT. 1940
PUBLIC LAW 104-191—AUG. 21, 1996
offering group health insurance coverage, may, with respect to
a participant or beneficiary, impose a preexisting condition exclusion
only if—
"(1) such exclusion relates to a condition (whether physical
or mental), regardless of the cause of the condition, for which
medical advice, diagnosis, care, or treatment was recommended
or received within the 6-month period ending on the enrollment
date;
"(2) such exclusion extends for a period of not more than
12 months (or 18 months in the case of a late enrollee) after
the enrollment date; and
"(3) the period of any such preexisting condition exclusion
is reduced by the aggregate of the periods of creditable coverage
(if any, as defined in subsection (c)(1)) applicable to the participguit or beneficiary as of the enrollment date.
"(b) DEFINITIONS.— For 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) 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 ENROLLEE.— The 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 DEFINED.— For purposes of this
part, 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.
"(D) Title XIX of the Social Security Act, other than
coverage consisting solely of benefits under section 1928.
"(E) Chapter 55 of title 10, United States Code.
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