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How Does the 63-Day Rule Affect My Pre-existing Condition Coverage?

From Kelly Montgomery, for About.com

Updated: February 18, 2009

About.com Health's Disease and Condition content is reviewed by our Medical Review Board

Question: How Does the 63-Day Rule Affect My Pre-existing Condition Coverage?
Answer:

If you are losing your current health coverage or switching insurance, you may be concerned about whether your new insurance will cover your pre-existing condition. Maintaining continuous coverage is the key to avoiding problems. And in order for coverage to be continuous, there cannot be a lapse in coverage of more than 63 days.

This 63-day rule applies to people who are leaving a group health plan, usually obtained through work. Once an individual leaves the plan, they have 63 days to find new coverage. If they have a lapse in coverage of more than 63 days, then their coverage is not continuous and their new plan can exclude coverage for their pre-existing condition.

Fortunately, waiting periods do not count toward the 63 days. So if you obtain a new job that requires you to wait 6 months before you can join the company's health plan, that new plan will still cover your pre-existing condition, provided that you don't delay your enrollment. The clock starts ticking the day your prior coverage ends, and only stops for the duration of the waiting period.

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