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Switching Jobs and Insurance
Feb 13, 2003

I have currently worked at my present employer for nearly 2 years. I have great insurance thru them. A group plan. I am considering switching jobs. I am a nurse and most places here in Texas, offer nurses insurance on the first day of the following month of your employment hire date. (say i get hired april 10th, my insurance would begin May 1st). I have read the previous questions regarding pre-existing clause. My diagosis date is less than the time of how long i have been carried by my current employers insurance coverage. I am just wondering what problems or would i still be able to be covered by any insurance company if i do not have the 63 day break in coverage? I do understand that i would have to get a cert. of insurance from my former (soon to be) employer.

Thank You.

T in Texas

Response from Ms. Franzoi

Using your example, if you were to leave your current job on April 1 and start a new job on April 10 that provided you with medical coverage effective May 1, you would not have to worry about a pre-existing condition clause. The maximum pre-existing exclusion period a plan can have is 12 months and the plan must recognize prior periods of coverage("creditable coverage") as long as you do not go more than 63 days without coverage. So in this example, let's assume that your new benefits commence May 1 and there is a 12-month pre-existing condition exclusion clause. Even if your prior coverage ended on April 1 and you did not elect COBRA, when your new coverage commences on May 1, you would not have had a break in coverage greater than 63 days. So the new plan would have to recognize your creditable coverage from your prior employer (which you stated was 2 years) and this is greater than a 12-month exclusion period so no pre-existing condition exclusion clause would apply to you.

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