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What you need to know before buying Health Insurance  

Is pregnancy a Pre-Existing condition? Maternity Insurance

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HIPAA Protects Your Rights to Health Care Coverage When You Change Jobs

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) protects health insurance coverage for workers and their families if they change or lose their jobs. This means that group health plans are prohibited from establishing eligibility requirements for enrollees or determining premiums for plan participants based on current health status, medical history, genetic data or disability.

Prior to HIPAA becoming law

If you changed group health plans, the insurer could consider any medical conditions you had as pre-existing and exclude them from coverage. HIPAA sets limits on the extent to which an insurer can exclude pre-existing conditions from coverage. If you've had "creditable" health insurance coverage for 12 consecutive months, and there has been no lapse in coverage of 63 days or more, a new group health plan must cover all of your medical conditions upon enrollment.

The following health plans are considered creditable health insurance coverage:

· A group health plan.

· Medicare.

· Medicaid.

· Health care programs offered by the military or the Indian Health Service.

· Health benefit plans offered by the Peace Corps.

· A state high-risk pool.

· The Federal Employees Health Benefit Program.

· Public health plans established or maintained by a state or local government.

If you didn't have a full 12 months of creditable health insurance coverage, or your coverage was from a foreign insurance company, when you enroll in a new group plan the insurer can exclude any of your existing medical conditions except for pregnancy (if the insurance provides coverage for maternity). However, your new plan must reduce your pre-existing condition exclusion period by the number of days of any creditable coverage you did have. Pre-existing conditions exclusions can be invoked for a maximum of 12 months. Late enrollees might have to wait as long as 18 months for coverage of pre-existing conditions.

There are limitations on your rights to health care coverage beyond what HIPAA imposes. For example, federal law doesn't require employers to provide or pay for employee health coverage. Most states leave the decision to offer health coverage up to the individual employer. And, employers that offer health coverage aren't required to cover all health conditions. Each state determines the levels of mandated coverage an employer must have.

In addition to these limits, when you switch jobs, HIPAA doesn't guarantee the same level of benefits, deductibles and claim limits you had under your prior group health coverage. It doesn't protect against cancellation of coverage if you-or your employer-don't pay the premiums, commit fraud, violate plan rules or move outside of your insurer's service area. HIPAA also permits a waiting period before you become eligible to join a new group health plan. If your plan has a waiting period, it doesn'tcount as a lapse in health coverage.

HIPAA requirements do not apply to:

· Coverage for accidental death or dismemberment or disability income insurance.

· Liability insurance.

· Supplements to liability insurance.

· Workers' compensation.

· Automobile medical payment insurance.

· Credit-only insurance.

· Coverage for on-site medical clinics.

HIPAA applies to every employer group health plan that has at least two participants who are current employees. It also applies to companies that are self-insured. States have the option of mandating that groups with only one participant follow HIPAA rules.

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