Your Rights Under Job-Based Coverage

HIPAA

The Health Insurance Portability and Accountability Act of 1996 made the most comprehensive changes to job-based health insurance coverage. HIPAA helps people get and keep health coverage by making it easier to qualify for coverage through their job, and helping them stay covered as they transition in and out of job-based coverage.

Some of the important protections offered by HIPAA are:

• Nondiscrimination –If an employer offers health insurance as part of its benefits package, it must offer that plan to all employees, regardless of health status. This is true no matter how many employees are in the company.
• Limits on Pre-existing Condition Exclusion Periods
  • The plan may exclude coverage for existing medical conditions “for which medical advice, diagnosis, care, or treatment was recommended or received within the 6-month period ending on the enrollment date”
  • The exclusion period may only last for up to 12 months (18 months if you are a late enrollee)
  • The exclusion period may be reduced by the amount of time you spent under prior creditable coverage:
    • Virtually any type of coverage you had previously could count as prior creditable coverage, including job-based coverage, an individual policy, Medicare, Medicaid, and state high risk pool coverage.
    • This prior creditable coverage does not count if it ended more than 63 days prior to enrollment in the current health plan.
• Guaranteed Renewability – under HIPAA, all coverage must be renewed each year, no matter how many claims you make.