In determining pre-existing condition eligibility for a group plan, what is the maximum allowable gap in days between health coverage periods?

• A. 63 days
• B. 14 days
• C. 90 days
• D. 180 days

Answer: (A)

Creditable coverage and how gaps in coverage affect pre-existing condition eligibility are being tested. For a group plan, the time you had health coverage before the new plan can count toward reducing or waiving the pre-existing condition exclusion only if the gap between coverage periods is 63 days or less. If the gap is 63 days or shorter, the prior coverage is credited, which can shorten or eliminate the pre-existing condition waiting period when you enroll in the new plan. If the gap is longer than 63 days, that prior coverage isn’t credited, and the new plan may apply its standard pre-existing condition exclusion based on the enrollment date. In short, 63 days is the cutoff that determines whether prior coverage helps with the pre-existing condition rule.