HIPAA:
Your rights to health insurance
portability
You have the ability to move from job to job without the fear of
losing your health insurance coverage. If you are worried about your
coverage when planning to leave jobs, the federal law called HIPAA
could protect you.
The Kassebaum-Kennedy Act, also known as the Health Insurance
Portability and Accountability Act of 1996, was designed to allow
workers to move from one company to another without the fear of
losing health insurance coverage.
Your pre-existing conditions are covered
Many health insurance companies like to exclude pre-existing
conditions when they offer coverage. They do this as a way to hold
down their costs by limiting claims.
Pre-existing conditions are any conditions that you have before
buying the health plan. There is a lot of debate in the insurance
world concerning pre-existing conditions.
Before HIPAA, if you had a medical condition, you might find it
near impossible to switch jobs. If you did, you were facing a new
insurance company that would consider your medical condition as
pre-existing. The company would refuse to cover any treatment in
regards to the condition. You would have to pay for all of your
medical treatment for the condition out of your own pocket.
This situation made it impossible for many employees to move
jobs.
HIPAA imposes a limit on group health plans that want to exclude
pre-existing conditions. For example, if you have health insurance
for 12 straight months with no lapse in coverage of over 63 days, a
new group health plan cannot use the pre-existing condition
exclusion. It must cover your medical problems.
The previous coverage must be creditable. It can be a group
health plan, Medicare, Medicaid, a military-sponsored health care
plan, Indian Health Services, state high-risk insurance pool,
federal Employees Health Benefit Program, a public health plan or a
Peace Corp member plan.
If you are not switching from a creditable health policy upon
enrolling in a new group plan, your new insurer can refuse to pay
for your existing medical conditions, except for pregnancy.
Maternity restrictions are only legal for a maximum of 12 months.
Some group health plans are known for excluding pre-existing
conditions for 18 months. This helps them to offset costs incurred.
What does HIPAA mean to you?
HIPAA ensures that group health plans cannot deny your
application for coverage based only on your health status. It limits
the exclusion on pre-existing conditions by health insurance
providers. You cannot be denied coverage based on mental illness,
genetic information, disability or your past claims history.
Group health plans that offer maternity coverage are not allowed
to consider a current pregnancy a pre-existing condition. They must
provide coverage for prenatal care and delivery, no matter your
employment or health insurance history. This is true for the insured
and the dependents.
Every employer group health plan with two participants or more
are required to follow HIPAA's rules. Some states even apply the
rules to groups that only contain one employee. They use it as a way
to protect the self-employed. Some states have added additional laws
that protect health insurance applicants, offering employees more
rights.
The only exception is that there is no protection when switching
from one individual health plan to another individual health plan.
Other conditions of HIPAA
There are many exceptions, conditions and loopholes that come
with HIPAA. You should fully understand your rights in regards to
your situation before you change your health plan.
Employers are not required to offer or pay for part or all of an
employee health insurance plan. Your employer can choose not to
offer health insurance as a benefit. Some employers offer only
medical insurance, with no coverage for mental health of maternity.
Others offer the whole package.
HIPAA allows you full coverage of your medical conditions, yet it
doesn't guarantee the same level of benefits, deductibles and claim
limits as your former insurance. These factors are set by the
company and employer.
HIPAA requirements do not apply to:
-Coverage for accidental death or dismemberment -Disability
insurance coverage -Liability insurance -Workers
compensation -MedPay -Credit-only insurance -Coverage for
on-site medical facilities
Lapses in coverage If you have had a lapse in your health
insurance coverage, you may face a period of exclusion for
pre-existing conditions. For example, if you haven't had health
insurance for six months, you may have to take a 12-month exclusion
period on your pre-existing conditions with your new health
insurance.
In order to have continuous full coverage, you cannot have a
lapse in your health insurance coverage that is over 63 days. This
is where COBRA comes in.
If you leave a company before you start with a new one, you
should seriously consider maintaining your COBRA coverage. This is
expensive, but will allow you to maintain continuous coverage with
no exclusion period for pre-existing conditions.
When you leave a health plan, make sure you get a "certificate of
creditable coverage" from that plan. It will list your coverage
dates, policy ID number, insurer's name and address and the
dependents on the plan. This will make it easier to document your
rights under HIPAA.
You can also use your pay stubs that show deduction of health
insurance premiums, Explanation-of-benefit forms,
benefit-termination notice or verification from your doctor that
says you had prior coverage.
The individual plan and HIPAA
If your employer drops your group health coverage, HIPAA can make
it easier to obtain an individual health policy. You may be able to
buy an individual plan without facing exclusions for pre-existing
conditions.
You must be an eligible individual to qualify for individual
health coverage under HIPAA. This means you must:
-Have at least 18 months of continuous coverage prior to changing
plans. -Have been covered by a group plan, a government plan or
a church plan. -Not be eligible for coverage under a group
health plan, Medicare or Medicaid. -Have no other health
insurance. -Have not lost your coverage due to non-payment of
premiums of fraud. -Have elected and exhausted your COBRA that
was available under your previous plan.
There are no limits placed by HIPAA on the amount of premiums you
could be charged for individual health insurance. Your application
will not be rejected, but the premiums could be quite high if you
have medical conditions. This makes it important to shop
around for the best rates.