Section 2699.6213 - Pre-Existing Condition Exclusions(a) Participating carriers who are health maintenance organizations, exclusive provider organizations, health maintenance organizations offering a point of service option or exclusive provider organization's offering a point of service option may not subject enrollees to a pre-existing condition exclusion period.(b) Participating carriers who are preferred provider organizations or who offer an indemnity plan in the program may subject enrollees to a pre-existing condition exclusion period. During the pre-existing condition exclusion period, no benefits or services related to a pre-existing condition shall be covered.(c) The pre-existing condition exclusion period shall be six (6) months following the individual's effective date of coverage.(d) In determining whether a preexisting condition provision applies to any person, a participating carrier shall credit the time the person was covered under qualifying prior coverage, provided the person becomes eligible for coverage under the succeeding plan contract within 30 days of termination of prior coverage, exclusive of any waiting period, and applies for coverage with the succeeding plan contract within the applicable enrollment period. However, if a person's employment has ended, the availability of health coverage offered through employment or sponsored by an employer has terminated, or an employer's contribution toward health coverage has terminated, a plan shall credit the time the person was covered under qualifying prior coverage if the person becomes eligible for health coverage offered through employment or sponsored by an employer within one hundred eighty (180) calendar days, exclusive of any waiting period, and applies for coverage under the succeeding health benefit plan within the applicable period.Cal. Code Regs. Tit. 10, § 2699.6213
1. Renumbering of former section 2699.634 to section 2699.6213 filed 5-27-94; operative 5-27-94 (Register 94, No. 21).
2. New subsection (a) and subsection relettering filed 5-2-96; operative 6-1-96 (Register 96, No. 18).
3. Amendment of subsection (d) filed 5-5-97; operative 7-1-97 (Register 97, No. 19). Note: Authority cited: Section 10731, Insurance Code. Reference: Sections 10731 and 10741, Insurance Code.
1. Renumbering of former section 2699.634 to section 2699.6213 filed 5-27-94; operative 5-27-94 (Register 94, No. 21).
2. New subsection (a) and subsection relettering filed 5-2-96; operative 6-1-96 (Register 96, No. 18).
3. Amendment of subsection (d) filed 5-5-97; operative 7-1-97 (Register 97, No. 19).