Health Protection for Individual Insurance
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
Does HIPAA Protect American Workers Who Need Individual Insurance?
HIPAA offers the most protection to new employees who want to enroll in an employer's group health plan. For more information, see HIPAA Protection When Changing Jobs.
However, HIPAA offers limited protection to individuals who have no choice but to switch from a group health plan to individual insurance. This may occur when your employer discontinues health insurance benefits, when you lose your job, or if you decide to become self-employed. Under HIPAA, you are guaranteed the right to purchase individual insurance coverage without the threat of exclusion for pre-existing medical conditions if:
- You have had at least 18 months of continuous coverage without any significant breaks (significant break is being without insurance for more than 63 days)
- Your most recent insurance was under a group health plan, governmental plan, or church plan
- You are not eligible for coverage under another group plan
- You are not eligible for Medicare or Medicaid
- You purchased and used up all the COBRA, Temporary Continuation of Coverage, or State Continuation Coverage that was available to you
- Your coverage was not terminated due to non-payment or insurance fraud
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 04:30 PM PST
Did you find this article informative?