Pre-Existing Conditions & the Look-Back

Under the HIPAA framework (pre-2014, still exam-tested), a condition counts as pre-existing only if treated/diagnosed within the 6-month look-back before joining a plan. Exclusion periods max 12 months (18 for late enrollees), reduced month-for-month by creditable coverage (12+ months prior coverage = no exclusion). The ACA eliminated these exclusions entirely for major medical (group and individual) in 2014; the HIPAA numbers survive on the exam and in short-term and Medicare supplement policies. An impairment rider permanently excludes a disclosed condition.