dollar limit and preexisting condition exclusion

[Guest Brenda N.]

Would it be a violation of HIPAA to apply a dollar limit to a diagnosis before appling a preexisting condition limitation. For example, in the first 12 months of coverage a plan would benefit a diagnosis up to $500 before investigating to see if it is a preexisting condition. If the diagnosis is then determined to be preexisting, creditable coverage would still apply.

[Ron Snyder]

You may have implied to answer to your own question: it depends on how the plan is drafted. If the coverage is excluded because is is a pre-existing condition limitation, it would violate HIPAA. However, if the the coverage is provided but the allowable benefit stated is two-tiered, it should be exmpt from HIPAA concerns.