Health Insurance When Changing Jobs
What Is HIPAA?
The Health Insurance Portability and Accountability Act (HIPPA) was enacted to reform healthcare in America. The HIPAA legislation had several objectives:
- Protect health insurance coverage for working Americans who have pre-existing medical conditions when they change or lose their jobs
- Reduce healthcare fraud and abuse
- Enforce standards for health information
- Guarantee security and privacy of health information
What Is a Pre-existing Medical Condition?
A pre-existing medical condition is a condition for which you received medical advice, diagnosis, care or treatment prior to enrolling in a new health plan. Cancer is an all-too common example of a pre-existing condition. Before HIPAA, your new employer's health plan would probably refuse to cover the cancer treatment for several years, if at all, if you had been treated for the cancer prior to your enrollment.
How Does HIPAA Protect American Workers?
HIPAA protects working Americans who are seeking to switch into a new group health plan, as when changing jobs. First, health insurers cannot deny you coverage or charge you more for your coverage because of your health status.
Second, HIPAA limits pre-existing medical conditions to a condition for which you received medical advice, diagnosis, care or treatment 6 months prior to enrolling in a new health plan. A condition that has not received medical attention in the last 6 months is not pre-existing, and a group health plan cannot exclude the condition from your coverage.
What if I Do Have a Pre-Existing Medical Condition?
If you do have a pre-existing medical condition (treated in the last 6 months), your new group health plan can only exclude the condition from your coverage for a maximum of 12 months.
Moreover, the new insurance company must give you credit for continuous health coverage that you had prior to enrolling in the new plan. Therefore, if you had 4 months of continuous coverage before switching health plans, the new health plan can only exclude your condition for a maximum of 8 months. If you have 12 months of continuous coverage before switching health plans, the new health plan cannot exclude your condition from coverage at all.
Anything shorter than a 63-day break in health coverage qualifies as ¿continuous coverage.¿ Individual insurance plans, Medicare and Medicaid generally qualify as creditable insurance coverage.
Are There Any Limitations to HIPAA Protections?
Your protections under the HIPAA laws will be limited if there is more than a 63-day break in your health coverage. Additionally, HIPAA offers the most protection to individuals switching into a group health plan. Those individuals who are switching from a group health plan to individual insurance only have very limited protections under HIPAA. For more information, see HIPAA Protection For Individual Health Plans. HIPAA does not protect anyone switching between individual insurance plans.
What Can I Do to Ensure that My Rights Are Protected under HIPAA?
Whenever you leave any health plan, make sure that you get a "certificate of creditable coverage" in writing. Your certificate should include:
- Your coverage dates
- Your policy ID number
- The insurer's name and address
- Any family members included under your coverage
Do I Need a Lawyer to Help Me with My HIPAA Problem?
Interpreting the HIPAA laws can be complicated. An experienced health insurance attorney can help you understand your rights under the HIPAA laws. If you believe your health insurance company is acting in bad faith and improperly denying you coverage, an attorney will know all the ins-and-outs of taking on a big health insurance company.
Consult a Lawyer - Present Your Case Now!
Last Modified: 11-22-2011 04:29 PM PST
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