Health Insurance Portability and Accountability Act

What You Need to Know About HIPAA (Title I)

Health Insurance
If you lose your job, you shouldn't have to lose your health insurance too. PhotoAlto/Frederic Cirou / PhotoAlto Agency RF Collections / Getty Images

The Health Insurance Portability and Accountability Act (HIPAA) became a law in 1996. We often think about it in regard to how it protects our privacy when we go to the doctor or hospital but that isn't all this law does. Title I of HIPAA protects your rights to health insurance coverage when you change jobs, lose a job, get divorced, become pregnant, or move. In this article we will discuss HIPAA as it applies to employment.

When you leave a job you may be concerned about continuation of your health insurance coverage. If you have a preexisting health condition you may worry that you will be denied coverage by your new employer's health insurance issuer. Or, if it takes you a while to find a new job, your new employer doesn't offer health coverage, or if you decide to become self employed, you may worry that you won't be able to purchase an individual health insurance policy. Here are some facts about the Health Insurance Portability and Accountability Act that may ease your worries. The information here is very general and only attempts to help you get a better understanding of the Health Insurance Portability and Accountability Act. For more in-depth information, please see the Centers for Medicaid and Medicare Web Site.

HIPAA and Group Health Insurance

  • Under HIPAA you cannot be denied group health insurance because of any health factors.
  • You can be denied coverage if you don't meet the eligibility requirements of your employer. Eligibility requirements may be based on the number of hours you work or whether you are an hourly or salaried employer.
  • As a new employee you may have to wait a period of time before you can enroll in the health insurance plan. This is called a waiting period if it imposed by the employer, or an affiliation period if it imposed by a managed care organization.
  • An employer can require that you must be at work on the day your health coverage is to begin unless you're absent due to a health factor. An employer can delay your coverage if you haven't yet begun work.
  • If you or your dependents are covered under your spouse's insurance plan and he or she becomes unemployed, your employer's insurance company (if it provides coverage to spouses and dependents) must allow for special enrollment. The same applies if you need to add a dependent, i.e. the birth or adoption of a baby or marriage.
  • If you have at least 12 months of continuous creditable coverage, a group health plan can't apply preexisting condition exclusions to your coverage. Creditable coverage includes most kinds of health insurance except health insurance that you had before a significant break in coverage (63 or more days in a row without health insurance coverage). During a preexisting condition exclusion period your insurer will not pay for treatment related to a preexisting condition but must pay for unrelated treatment.
  • One employee can't be required to pay higher premiums than other similarly-situated employees. Similarly situated employees are those in the same employment category.

    More About HIPAA: Individual Health Coverage

    Disclaimer: Please note that the information on this website is for guidance, ideas and assistance only. Dawn Rosenberg McKay makes every effort to offer accurate advice and information on this site. She is not, however, an attorney, and the content on the site is not to be construed as legal advice. Employment laws and regulations vary by location so check government resources or legal counsel when in doubt about your particular situation.

    HIPAA and Individual Health Insurance Coverage

    There are situations in which you might like to or need to purchase your own insurance policy. This may be the case if you can't find a job and any other coverage you have has expired. You may also be hired by an employer who doesn't offer a group health plan or you may decide to become self employed. It is generally not a good idea to go without health insurance. A catastrophic illness, for example cancer, can decimate your life savings. Furthermore, if you are without health insurance for 63 or more days, you will lose some of your HIPAA rights and protections. HIPAA-eligible individuals are guaranteed the right to purchase individual coverage. You are considered HIPAA-eligible if:
    • you have had at least 18 months of continuous coverage without any significant breaks
    • your most recent insurance was under a group plan
    • you aren't eligible for coverage under another group plan
    • your coverage wasn't terminated due to non-payment of premiums or insurance fraud
    • you aren't eligible for Medicare or Medicaid
    • you purchased and exhausted COBRA, Temporary Continuation of Coverage, or State Continuation Coverage, if they were offered to you

    What HIPAA Doesn't Do

    • It doesn't require that employers provide group health insurance for their employees.
    • It doesn't require a company's health insurance plan to include family or dependant coverage.
    • It doesn't regulate the coverage group plans offer.
    • It doesn't regulate premium rates.

    Additional Information About HIPAA

    • A break in insurance coverage of 63 days or more will cause you to lose some of your HIPAA rights and protections.
    • You can request a free certificate of creditable coverage from your prior insurance carrier; it will state the length of time you were covered by that carrier.

      More About HIPAA: Group Health Coverage

      Disclaimer: Please note that the information on this website is for guidance, ideas and assistance only. Dawn Rosenberg McKay makes every effort to offer accurate advice and information on this site. She is not, however, an attorney, and the content on the site is not to be construed as legal advice. Employment laws and regulations vary by location so check government resources or legal counsel when in doubt about your particular situation.

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