Is anyone out there familiar with this scenario: a plan provides coverage for pre-x conditions, but will only pay at the benefit levels provided under the old (credited) coverage? Naturally, this will only be applied where the old benefit is less rich than that provided under the new plan.


THIS IS A NEW ONE ON ME.

Could you clarify this a little? Are they providing reduced level of benefit at a time where there would be none (pre-ex time minus amount of creditable coverage) or are they providing reduced level even though there is creditable coverage? Either way I think you have a problem. If the first scenario, aren't you discriminating among similarly situated individuals if some of your enrollees have pre-ex partially waived and others don't? If they are not properly crediting creditable coverage you also have a problem.

Plus how would you obtain a plan document describing the old plan to know how it paid in the first place? It is tough enough just getting the certificate of creditable coverage.