Question

HIPAA has a ______ month exclusion window.

a) 3 months
b) 6 months
c) 12 months
d) 18 months

Answer 1

HIPAA includes a pre-existing condition exclusion window of 12 months for conditions that were recommended or treated within 6 months prior to the enrollment date, which can extend to 18 months for late enrollees.

Step-by-step explanation:

Under the Health Insurance Portability and Accountability Act (HIPAA), the term 'pre-existing condition exclusion' refers to a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the date of enrollment in a new health plan, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before such date. The HIPAA pre-existing condition exclusion window is 12 months for conditions for which medical advice, diagnosis, care, or treatment was recommended or received within the 6 months preceding the enrollment date in the plan. For late enrollees, this window could be extended to 18 months.