Pre-existing condition & significant break in coverage

[CO Bank]

Scenario: Employee hired May 1st. Coverage under prior employer ended April 15th. Our health plan has a 90 day waiting period before coverage begins. Employee's health coverage with our company begins August 1st. Employee did not elect COBRA, and thus did not have any insurance coverage from April 15th to August 1st.

Did employee incur a significant break in coverage?

I read on this website that waiting periods are not counted as a signficant break in coverage:

http://www.familiesusa.org/issues/private-...efinitions.html

http://www.dol.gov/ebsa/regs/fedreg/final/2004028112.pdf

But the term 'waiting period' seems ill defined.

The employee has a pre-existing condition. They have a certficate of coverage from prior employer, which is not relevant if the significant break in coverage applies.

Thoughts anyone?

[leevena]

A couple of things.

1. I did not bother to read your links, too long. You may want to give us a head's up by stating what page/paragraph, etc.

2. Don't rely on non-govt sites, while they are usually correct, they are not definitive. I always use the govt site, such as DOL in this case.

Per your question, waiting period cannot be counted. So based on your example, there is only 15 days without coverage.

here is wha the dol site says.

Generally, a significant break in coverage is a period of 63 consecutive days during which you have no creditable coverage. In some states, the period is longer if your plan coverage is provided through an insurance policy or HMO. Days in a waiting period during which you had no other health coverage cannot be counted toward determining a significant break in coverage.

Your links are:

http://www.dol.gov/elaws/ebsa/health/gloss...eak_in_Coverage

http://www.dol.gov/elaws/ebsa/health/gloss...=Waiting_Period

have a good day.

Lee

[CO Bank]

Thank you, appreciate your help!