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HMOsProtections in Small Group MarketsProtections in Individual Insurance MarketsOther State ProtectionsMental Health CoverageHigh Risk PoolsMandated Benefits in Private InsurancePatients' Rights RequirementsHealth Insurance ReformTax IncentivesState High Risk Pool Pre-Existing Condition Exclusion and Look Back Periods, January 2009
| State High-Risk Pool Imposes a Pre-existing Condition Exclusion Period? | Definition of Pre-existing Condition | Pre-ex Exclusion Period | Lookback Period | Credit for Prior Coverage | |
|---|---|---|---|---|---|
| United States | NA | NA | NA | NA | NA |
| Alabama | No | NA1 | 0 | 0 | NA |
| Alaska | Yes | Prudent person standard | 6 months | 3 months | Under limited circumstances |
| Arizona | NA | NA | NA | NA | NA |
| Arkansas | Yes | Prudent person and Objective standards | 6 months | 6 months | Under limited circumstances |
| California | Yes | Objective standard | 3 months | 6 months | Yes |
| Colorado | Yes | Objective standard | 6 months | 6 months | Yes |
| Connecticut | Yes | Prudent person and Object standards | 12 months | 6 months | Under limited circumstances |
| Delaware | NA | NA | NA | NA | NA |
| District of Columbia | NA | NA | NA | NA | NA |
| Florida | NA2 | NA | NA | NA | NA |
| Georgia | NA | NA | NA | NA | NA |
| Hawaii | NA | NA | NA | NA | NA |
| Idaho | NA | NA | NA | NA | NA |
| Illinois | Yes | Objective standard | 6 months | 6 months | Under limited circumstances |
| Indiana | Yes | Objective standard | 3 months | 3 months | Yes |
| Iowa | Yes | Prudent person standard | 6 months | 6 months | Under limited circumstances |
| Kansas | Yes | Prudent person and Object standards | 90 days (~3 months) | 6 months | Yes |
| Kentucky | Yes | Objective standard | 12 months | 6 months | Yes |
| Louisiana | Yes | Prudent person standard | 6 months | 6 months | Under limited circumstances |
| Maine | NA | NA | NA | NA | NA |
| Maryland | Yes | Objective standard | 2 months | 6 months | Yes |
| Massachusetts | NA | NA | NA | NA | NA |
| Michigan | NA | NA | NA | NA | NA |
| Minnesota | Yes | Objective standard | 6 months | 90 days (~3 months) | Yes |
| Mississippi | Yes | Objective standard | 12 months3 | 6 months | Under limited circumstances |
| Missouri | Yes | Prudent person and Objective standards | 12 months | 6 months | Under limited circumstances |
| Montana | Yes | Objective standard | 12 months | 3 years | Yes |
| Nebraska | Yes | Prudent person and Objective standards | 6 months | 6 months | Under limited circumstances |
| Nevada | NA | NA | NA | NA | NA |
| New Hampshire | Yes | Prudent person and Objective standard | 9 months | 3 months | Yes |
| New Jersey | NA | NA | NA | NA | NA |
| New Mexico | Yes | Objective standard | 6 months | 6 months | Yes |
| New York | NA | NA | NA | NA | NA |
| North Carolina | Yes | Objective standard | 6 months4 | 12 months | Yes |
| North Dakota | Yes | Objective standard | 180 days (~6 months)5 | 180 days (~6 months) | Yes |
| Ohio | NA | NA | NA | NA | NA |
| Oklahoma | Yes | Prudent person and Objective standards | 12 months | 6 months | Yes |
| Oregon | Yes | Objective standard | 6 months | 6 months | Yes |
| Pennsylvania | NA | NA | NA | NA | NA |
| Rhode Island | NA | NA | NA | NA | NA |
| South Carolina | Yes | Prudent person and Objective standards | 6 months | 6 months | Under limited circumstances |
| South Dakota | No | NA1 | 0 | 0 | NA |
| Tennessee | Yes | Prudent person | 6 months6 | 6 months | No |
| Texas | Yes | Prudent person and Objective standard | 12 months | 6 months | Under limited circumstances |
| Utah | Yes | Prudent person | 6 months | 6 months/10 months for maternity | Under limited circumstances |
| Vermont | NA | NA | NA | NA | NA |
| Virginia | NA | NA | NA | NA | NA |
| Washington | Yes | Prudent person and Objective standards | 6 months | 6 months | Yes |
| West Virginia | Yes | Objective standard | 6 months | 6 months | Under limited circumstances |
| Wisconsin | Yes | Prudent person standard | 6 months | 6 months | No |
| Wyoming | Yes | Objective standard | 12 months | 6 months | Yes |
| Notes: | Data as of January 31, 2009. |
| Sources: | Data collection and analysis by Eliza Bangit and Karen Pollitz, Health Policy Institute, Georgetown University. Sources include state laws and regulations, interviews with state high-risk pool staff, state high-risk pool websites, and the Comprehensive Health Insurance for High-Risk Individuals: A State-by-State Analysis. National Association of State Comprehensive Health Insurance Plans, 22nd Ed., 2008/2009. Available for order at www.naschip.org. |
| Definitions: | Pre-existing Conditions: In general, pre-existing conditions are medical conditions or other health problems that existed before the date of enrollment. However, the exact definition of pre-existing condition varies by state. Some states use an objective standard allowing only those conditions for which someone actually received medical advice, diagnosis, care or treatment prior to enrollment to be counted as pre-existing. Other states use a broader, prudent person standard, which also includes conditions that were never diagnosed, but which exhibited symptoms for which an ordinary prudent person would have sought medical advice, care or treatment. Pre-existing Exclusion Period: The time for which coverage is excluded following the effective date of coverage for conditions that manifested itself or for which medical advice or treatment was received during a period prior to the effective date of coverage. Look Back: The maximum length of time, immediately prior to enrolling in a health plan, that can be examined for evidence of pre-existing conditions. |
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