The federal government enacted Health Insurance Portability and Accountability Act (HIPPA) 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. However, HIPAA offers limited protection to individuals who have no choice but to switch from a group health plan to individual insurance. This required switch 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 in your coverage (a significant break is more than 63 days)
  • Your most recent insurance was under a group health plan, government 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?

One thing you can do is obtain a “certificate of creditable coverage” in writing when you leave your health plan. 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. A qualified insurance lawyer can help you understand how you are protected 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.