North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-11 - Regulation on the Crediting of Qualifying Previous Coverage Toward the Reduction of Preexisting Condition Exclusion Periods › Section 45-06-11-02 - Methods of crediting coverage

Current through Supplement No. 393, July, 2024
1. Any
				health carrier offering health insurance in this state must reduce any time
				period applicable to a preexisting condition exclusion or limitation period by
				the aggregate of periods the individual was covered by qualifying previous
				coverage, if any, if the qualifying previous coverage was continuous until at
				least sixty-three days prior to the effective date of the new coverage. The
				health carrier must credit coverage by either a standard or alternative method.
2. A health carrier electing to
				credit coverage by the standard method shall determine the amount of qualifying
				previous coverage without regard to the specific benefits covered during the
				period of qualifying previous coverage.
3. For purposes of reducing the preexisting
				condition exclusion period under the standard method, a health carrier
				determines the amount of qualifying previous coverage by counting all the days
				that the individual has under one or more types of qualifying previous
				coverage. If an individual is covered by more than one source of qualifying
				previous coverage on any given day, all the qualifying previous coverage on
				that day is counted as one day. Days spent in a waiting period for a plan or
				policy are not days of qualifying previous coverage.
4. Days of qualifying previous coverage
				occurring before a significant break in coverage are not required to be counted
				by the plan or issuer in reducing the preexisting condition exclusion. A
				significant break in coverage means a period of sixty-three consecutive days
				during all of which the individual was not covered by any qualifying previous
				coverage. Waiting periods are not taken into account in determining a
				significant break in coverage.
5.
				A health carrier offering health insurance in this state may elect to use an
				alternative method of crediting coverage. In applying the alternative method,
				coverage may be credited based on coverage of benefits within the following
				five categories of benefits:
a. Mental
				health;
b. Substance abuse
				treatment;
c. Prescription drugs;
d. Dental care; or
e. Vision care.
Any health carrier offering health insurance in this state
				  may use the alternative method for any or all of the five categories and may
				  apply a different preexisting condition exclusion with respect to each
				  category. The qualifying previous coverage determined for a category of
				  benefits applies only for purposes of reducing the preexisting condition
				  exclusion period with respect to that category. For coverage that is not within
				  the above categories, qualifying previous coverage is determined by using the
				  standard method. A health carrier using the alternative method is required to
				  apply it in a uniform manner.