Cal. Health and Safety Code § 1357.51 : California Health And Safety Code — Licensing Provisions — Health Care Service Plans — Preexisting Condition Provisions — Preexisting condition provision Date: 15 Sep 2016 TEXT PDF Current through the 2016 Legislative Session (a) A health benefit plan for group coverage shall not impose a preexisting condition provision or waivered condition provision upon an enrollee. (b) (1) A nongrandfathered health benefit plan for individual coverage shall not impose a preexisting condition provision or waivered condition provision upon an enrollee. (2) A grandfathered health benefit plan for individual coverage shall not exclude coverage on the basis of a waivered condition provision or preexisting condition provision for a period greater than 12 months following the enrollee's effective date of coverage, nor limit or exclude coverage for a specific enrollee by type of illness, treatment, medical condition, or accident, except for satisfaction of a preexisting condition provision or waivered condition provision pursuant to this article. Waivered condition provisions or preexisting condition provisions contained in individual grandfathered health benefit plans may relate only to conditions for which medical advice, diagnosis, care, or treatment, including use of prescription drugs, was recommended or received from a licensed health practitioner during the 12 months immediately preceding the effective date of coverage. (3) If Section 5000A of the Internal Revenue Code, as added by Section 1501 of PPACA, is repealed or amended to no longer apply to the individual market, as defined in Section 2791 of the Public Health Service Act ( 42 U.S.C. Sec. 300gg-91 ), paragraph (1) shall become inoperative 12 months after the date of that repeal or amendment and thereafter paragraph (2) shall apply also to nongrandfathered health benefit plans for individual coverage. (4) In determining whether a preexisting condition provision or a waivered condition provision applies to an individual under this subdivision, a plan shall credit the time the individual was covered under creditable coverage, provided that the individual becomes eligible for coverage under the succeeding plan contract within 62 days of termination of prior coverage and applies for coverage under the succeeding plan within the applicable enrollment period. (c) A health benefit plan for group or individual coverage shall not impose a waiting or affiliation period. Ca. Health and Saf. Code § 1357.51 Amended by Stats 2014 ch 195 (SB 1034),s 2, eff. 1/1/2015. Amended by Stats 2014 ch 71 (SB 1304),s 83, eff. 1/1/2015. Amended by Stats 2013 ch 2 (SB X1-2),s 1, eff. 9/30/2013. Added by Stats 2012 ch 852 (AB 1083),s 4, eff. 1/1/2013.