Section 1357.51 Of Article 3.15. Preexisting Condition Provisions From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 3.15.
1357.51
. (a) A health benefit plan for group coverage shall not
impose any preexisting condition provision or waivered condition
provision upon any enrollee.
(b) (1) A nongrandfathered health benefit plan for individual
coverage shall not impose any preexisting condition provision or
waivered condition provision upon any enrollee.
(2) A grandfathered health benefit plan for individual coverage
shall not exclude coverage on the basis of a waivered condition
provision or preexisting condition provision for a period greater
than 12 months following the enrollee's effective date of coverage,
nor limit or exclude coverage for a specific enrollee by type of
illness, treatment, medical condition, or accident, except for
satisfaction of a preexisting condition provision or waivered
condition provision pursuant to this article. Waivered condition
provisions or preexisting condition provisions contained in
individual grandfathered health benefit plans may relate only to
conditions for which medical advice, diagnosis, care, or treatment,
including use of prescription drugs, was recommended or received from
a licensed health practitioner during the 12 months immediately
preceding the effective date of coverage.
(3) If Section 5000A of the Internal Revenue Code, as added by
Section 1501 of PPACA, is repealed or amended to no longer apply to
the individual market, as defined in Section 2791 of the Public
Health Service Act (42 U.S.C. Sec. 300gg-91), paragraph (1) shall
become inoperative 12 months after the date of that repeal or
amendment and thereafter paragraph (2) shall apply also to
nongrandfathered health benefit plans for individual coverage.
(4) In determining whether a preexisting condition provision or a
waivered condition provision applies to an individual under this
subdivision, a plan shall credit the time the individual was covered
under creditable coverage, provided that the individual becomes
eligible for coverage under the succeeding plan contract within 62
days of termination of prior coverage and applies for coverage under
the succeeding plan within the applicable enrollment period.
(c) A health benefit plan for group or individual coverage shall
not impose any waiting or affiliation period.