 | | | AB 1672: Frequently Asked Questions
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1) What is the difference between group health coverage and group health insurance? |
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Group health coverage is any plan offered by a group such as an employer or association.
Group health insurance, on the other hand, is coverage paid for with regular premium payments; examples include Preferred Provider Organizations (PPOs), Point of Service (POS) and Indemnity Plans.
In contrast to health insurance:
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2) What is AB 1672? |
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AB 1672 took in effect in 1993 under the California Insurance Code 10702. This state law contains California health insurance protections, allowing individuals with pre-existing medical conditions the ability to transition from an old health coverage plan to a new group health insurance plan. The law also enables small businesses, professional groups, and associations (with 2 to 50 individuals) to provide affordable health coverage options through a health insurance purchasing pool, known as PacAdvantage . |
3) Is AB 1672 health coverage? |
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No. AB 1672 contains health coverage protections for people with disabilities and pre-existing conditions who work or change jobs, as well as other important provisions on health care. |
4) What are some of the AB 1672 health protections? |
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AB 1672:
- Defines the size of an employer group in California as 2 or more individuals;
- Defines (in California) that a pre-existing condition is one for which you received treatment within six months prior to enrollment in group heath coverage;
- Allows you to use credit from previous private health coverage of six months or more to eliminate any pre-existing condition exclusionary period when entering new group health insurance;
- Allows a gap between a prior private health coverage plan and new coverage of up to 180 days; and
- Access to group health coverage for small employer groups in California through a health insurance purchasing pool known as PacAdvantage.
AB 1672 does not include Medicare or Medi-Cal as previous private health coverage.
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5) What is a pre-existing medical condition? |
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Under AB 1672, group health insurance defines a pre-existing medical condition as a condition for which an individual received treatment within the past six months prior to enrollment. Treatment is defined broadly and includes physician consultations and prescription medication.
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6) What is a pre-existing condition exclusion period? |
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A pre-existing condition exclusionary period is a time when a pre-exisiting condition is not covered under your health plan. Under, AB 1672, a maximum pre-existing condition exclusionary period cannot exceed six months. The pre-existing condition will normally be covered once this period has passed.
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7) Does AB 1672 apply to all types of health coverage? |
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- Health Maintenance Organization (HMO) coverage accessed through groups such as an employer or association do not contain pre-existing condition exclusionary periods in California.
- Self Insured Trust coverage through groups can have up to a 12-month pre-existing condition exclusionary period nationally, and are not covered under AB 1672.
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8) I receive Medicare and Medi-Cal services. Does AB 1672 apply to me? |
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No. Unlike the national health protection law HIPAA, this protection does not include Medi-Cal and Medicare as types of previous health coverage. |
9) How do I use prior health coverage as credit to eliminate a pre-existing condition exclusionary period for new group health insurance? |
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10) Are there any medical eligibility requirements for AB 1672? |
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No. AB 1672 is California health insurance reform allowing individuals with pre-existing medical conditions the ability to transition from group health coverage to group health insurance. This law also provides small employers the ability to access affordable employer-sponsored group health coverage. |
11) Does what I have in the bank or what I own, such as a home or car, affect my eligibility for AB 1672? |
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No. There are no limits on what you own or have in the bank to use AB 1672's protections.
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12) How do I prepare to access AB 1672 health coverage protections? |
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To use AB 1672, you will need to provide proof of previous coverage - for at least six months - when enrolling in new health coverage.
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13) How many months of previous coverage do I need for AB 1672 to eliminate a pre-existing condition exclusionary period? |
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If you had at least six months of previous health coverage, you can eliminate a pre-existing condition exclusionary period upon enrolling in new group insurance. However, the gap between previous and new coverage cannot exceed 180 days. |
14) Can I use AB 1672 protections while I am eligible for Medi-Cal? |
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Yes. Your eligibility for Medi-Cal has no affect on using AB 1672 protections.
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16) With the more recent HIPAA protections does AB 1672 still have value? |
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17) Are there rules for immigrants to qualify for the AB 1672? |
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No. Immigration rules that should be considered relate to your legal residency status and whether you are legally authorized to work in California.
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