HIPAA Rights on an Individual Health Plan
The Health Insurance Portability and Accountability Act (HIPPA) was implemented in 1996 as a way to protect the rights of consumers regarding health insurance coverage. It contains provisions for acquiring new coverage when group coverage is terminated because of events such as a job loss. In such situations, your previous insurer is required to issue you a Certificate of Creditable Coverage, which will facilitate the obtaining of new coverage in the individual market.
Other People Are Reading
-
HIPAA Eligible
-
If you are HIPAA eligible, you must be given a choice of at least two plans, To be HIPAA eligible, you must meet the following conditions: have 18 months of continuous creditable coverage, with a group health plan providing at least the last day of coverage, all COBRA benefits must have been exhausted, you must not currently be eligible for any group health plan, you must currently be uninsured or about to lose group coverage and you must apply for new insurance within 63 days of losing coverage.
Conversion Policies
-
If you are losing coverage under your group plan, you will be eligible for a conversion policy. With a conversion policy, you will continue to be covered for any pre-existing health conditions that were covered under your group policy, but you will likely pay a much higher premium for coverage.
-
Pre-existing Conditions
-
HIPAA eligible individuals also may not be denied coverage for pr-eexisting conditions. A pre-existing condition is one for which you have sought medical treatment of or advice for in the previous 12 months, including pregnancy. Insurers are permitted to charge a higher premium because of a pre-existing condition.
Options
-
In addition to a conversion policy or HIPAA eligible coverage, you also have the right to shop around and apply for any coverage available in the individual market. However, your application will be underwritten individually, meaning that you could be turned down for coverage based on your health history.
Other Rights
-
Under HIPAA, family members who were included under the group plan must also be covered under the new plan, but a higher premium may be charged for any preexisting conditions. Also, the insurer does not have the right to cancel coverage for any reason, except for not paying the premium or if the plan is no longer offered in your geographic region.
-
