---
kind: "section"
citation: "42 C.F.R. § 457.480"
title: "42"
number: "457.480"
heading: "Prohibited coverage limitations, preexisting condition exclusions, and relation to other laws."
url: "https://uscodex.org/cfr/42/457.480"
---

# §457.480. Prohibited coverage limitations, preexisting condition exclusions, and relation to other laws.

- (a) **Prohibited coverage limitations.** The State may not impose any annual, lifetime or other aggregate dollar limitations on any medical or dental services which are covered under the State plan.
- (b) **Preexisting condition exclusions.**
  - (1) Except as permitted under paragraph (a)(2) of this section, the State may not permit the imposition of any pre-existing condition exclusion for covered services under the State plan.
  - (2) If the State obtains health benefits coverage through payment or a contract for health benefits coverage under a group health plan or group health insurance coverage, the State may permit the imposition of a pre-existing condition exclusion but only to the extent that the exclusion is permitted under the applicable provisions of [part 7](/cfr/42/part7.md) of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (ERISA) and title XXVII of the Public Health Service Act.
- (c) **Relation of title XXI to other laws.**
  - (1) **ERISA.** Nothing in this title affects or modifies [section 514](/cfr/42/514.md) of ERISA with respect to a group health plan as defined by section 2791(a)(1) of the Public Health Service Act.
  - (2) **Health Insurance Portability and Accountability Act (HIPAA).** Health benefits coverage provided under a State plan and coverage provided as a cost-effective alternative, as described in [subpart J](/cfr/42/subpartJ.md) of this part, is creditable coverage for purposes of [part 7](/cfr/42/part7.md) of subtitle B of title II of ERISA, title XXVII of the Public Health Service Act, and subtitle K of the Internal Revenue Code of 1986.
  - (3) **Mental Health Parity Act (MHPA).** Health benefits coverage under a group health plan provided under a State plan must comply with the requirements of the MHPA of 1996 regarding parity in the application of annual and lifetime dollar limits to mental health benefits in accordance with [45 CFR 146.136](/cfr/45/146.136.md).
  - (4) **Newborns and Mothers Health Protection Act (NMHPA).** Health benefits coverage under a group health plan provided under a State plan must comply with the requirements of the NMHPA of 1996 regarding requirements for minimum hospital stays for mothers and newborns in accordance with 45 CFR [146.130](/cfr/45/146.130.md) and [148.170](/cfr/45/148.170.md).

## Notes

### Amendments

[66 FR 2678, Jan. 11, 2001, as amended at 89 FR 22876, Apr. 2, 2024]

### Source

Source: 66 FR 2678, Jan. 11, 2001, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302.

### Source

Source: 65 FR 33622, May 24, 2000, unless otherwise noted.

### Amendments

[66 FR 2678, Jan. 11, 2001, as amended at 89 FR 22876, Apr. 2, 2024]