Health Insurance Coverage Info For People With and Without Pre-existing Conditions

Until HIPAA (I used to spell the acronym the wrong way too), Health Insurance Portability and Accountability Act of 1996, went into effect, there wasn't much legal protection for those with employer-sponsored health insurance when they changed jobs. But now, all states are required to guarantee individual/family health insurance to HIPAA-eligible individuals without exclusions for preexisting conditions. Let's find out more about it.

Here is a list of 5 ways that HIPAA compliance protects you in the event of a job change or expiring COBRA coverage:

1. Guarantees continuous health insurance coverage for a preexisting condition when you change employers if your previous employer covered it. Your new employer cannot charge you more (or less) than the other employees.

2. Prohibits discrimination against you as an employee on the basis of your health. Certain medical conditions like pregnancy, genetically inherited diseases, and medical problems of a newborn or adopted child, cannot be excluded from coverage in an employer-sponsored group plan, which means pregnancy and newborns must be covered; including marriage to a pregnant woman.

3. Limits to 12 months the time period a new employer can exclude a preexisting condition from coverage if previous employer did not cover it.

4. All states are required to offer some type of healthcare coverage with no exclusions for preexisting conditions to individuals who have accepted and exhausted COBRA.

5. Sets privacy standards for medical providers and insurers. This is especially important if someone contacts your doctor, current or past employer, or health insurer for a reference.

5 different scenarios to becoming HIPAA-eligible:

1. Your most recent coverage must have been through an association or employer-sponsored group plan.

2. If COBRA continuation coverage is offered, it must be accepted and fully used, which is considered "continuous credible coverage" for at least 18 months without a break greater than 63 days long.

3. Insurance coverage must not have been lost due to nonpayment of premium.

4. You cannot be eligible for any other group plan, Medicare or Medicaid.

5. If no COBRA continuation coverage is offered due to employer (a) having 19 or fewer employees at the time of job loss, (b) voluntarily terminating its employer-sponsored group health benefits plan, or (c) health insurance company went out of business, then you are
HIPAA-eligible from the day you lose your employer-sponsored health benefits.

Always request a Certificate of Creditable Coverage!

In accordance with HIPAA compliance, health insurers are required to automatically give a Certificate of Creditable Coverage on request during coverage, when coverage is terminated, and for up to 24 months following coverage termination. But don't take that for granted. You should always request a certificate when terminating any health insurance plan. This certificate can be shown to your next employer or health insurer to prevent them from excluding any possible preexisting conditions that you or your family member may have.

If you have a preexisting condition or want to know what individual/family health insurance options are available, please visit http://www.HealthInsuranceCoverageInfo.com.