In determining whether a pre-existing condition applies, the enrollee CANNOT have more than how many...

In determining whether apre-existing condition exclusionapplies, Pennsylvania follows federal standards established under HIPAA and reinforced by ACA provisions. An enrolleecannot have a gap in creditable health coverage of more than 63 days. If the gap exceeds 63 days, prior coverage may no longer be credited toward eliminating or reducing a pre-existing condition limitation.

Pennsylvania-approved insurance education materials emphasize that creditable coverage includes most group and individual health plans, Medicare, Medicaid, and other qualifying coverage types. Maintaining continuous coverage is critical to preserving consumer protections. A lapse of63 days or fewerallows prior coverage to count without penalty, while exceeding that threshold resets the pre-existing condition evaluation.

The alternative answers—60, 65, and 70 days—do not reflect the legally established standard used in Pennsylvania and federal insurance regulation. The63-day ruleis a key exam concept and consumer protection mechanism designed to encourage continuous health coverage. Therefore,63 daysis the correct and fully verified answer.