The Health Insurance Portability and Accountability Act (HIPAA), also known as the Kennedy-Kassebaum Act, provides limited protection for employees when they change or lose their jobs. When you change or lose your job, ask your previous insurer for a "Certificate of Creditable Coverage". This will help protect your rights under HIPAA to health insurance coverage. You can obtain a certificate for free up to 24 months after the end of coverage.
HIPAA prohibits group health insurance plans from denying coverage or charging more for coverage based on pre-existing conditions or genetic information. Pre-existing condition exclusions for employees with prior continuous coverage are limited to 12 months in duration. (If you do not enroll when first eligible, the exclusion period can be up to 18 months in duration.) The pre-existing condition exclusion period is reduced by one day for each day of creditable coverage. Only conditions for which treatment, diagnosis or advice was received in the prior 6 months may be considered pre-existing conditions. In some cases pre-existing conditions can include conditions of which you were aware but for which you didn't seek treatment.
HIPAA does not, however, apply to individual health insurance policies. If you change jobs to an employer who does not offer a group plan, you may find it difficult to obtain coverage. Certain state and local government group plans, small employer group plans, and church group plans may also be exempt from HIPAA's requirements. Individual health insurance plans may therefore deny coverage for pre-existing conditions and can use any length "look-back" in the definition of a pre-existing condition (e.g., 2, 3 or even 5 years).
If you lose your job, you need to be careful to avoid a break in continuous coverage of 63 or more consecutive days. If you are offered COBRA, you should accept it. That will provide you with 18, 29 or 36 months of coverage. After you exhaust the COBRA coverage, you become eligibile for HIPAA insurance in the individual market (i.e., with no pre-existing condition exclusions). If you were not eligible for COBRA coverage, but had at least 18 months of creditable coverage in a group plan without a significant break in coverage, you are also eligible for HIPAA insurance. You may also be eligible for coverage in your state's high-risk pool.
HIPAA does not, however, limit the premiums you may be charged for the plan, although your state may set such limits (typically, no more than double). HIPAA insurance is also not guaranteed to be renewed if you move out of state or move outside a network plan's service area. If your insurance was obtained through an association, your coverage is not guaranteed to be renewed if you end your membership in the association. HIPAA also does not guarantee that you'll have the same coverage, deductibles and co-pays with the new plan.
You may be offered conversion coverage after your COBRA coverage ends or in place of COBRA coverage. Conversion coverage is not considered group coverage, so accepting conversion coverage may affect your rights under HIPAA.
You can lose your health insurance coverage and your HIPAA protections if you commit fraud against the insurance company. This can include intentionally failing to mention a pre-existing condition.
HIPAA does not apply to accidental death or dismemberment insurance, short and long-term disability insurance, worker's compensation, and liability insurance. Also, protections under HIPAA apply only to group health plans, not individual plans.
If you run into problems, seek help from your state insurance commissioner and your Congressman.
Tips
- Get a Certificate of Creditable Coverage from your old health insurance plan.
- Ask your new employer about the health insurance benefits and HIPAA.
- Investigate your state's health insurance coverage laws.
Copyright © 2005-2018 by Mark Kantrowitz. All rights reserved.
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