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Health Insurance Portability
& Accountability Act (HIPAA)
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About the HIPPA Act and How It Protects You:
The Health Insurance Portability and Accountability Act (HIPAA) gives workers rights over their health information and offers continuity and portability of health insurance coverage.
Through HIPAA, workers receive an umbrella of protection that:
- Limits exclusion from coverage due to preexisting health conditions
- Allows individuals to enroll for new health coverage after losing previous coverage, getting married or adding a dependent
- Prohibits discrimination during the enrollment process and in the premiums charged to employees
- Upholds the states' role in regulating health insurance
The HIPAA law has some exclusions for pre-existing conditions, but it is designed to protect workers by giving them rights that insurance companies and health
providers cannot violate. Different areas of insurance coverage are addressed under HIPAA regulations, and the law specifies what types of coverage count as
credible coverage. In addition, it lists special enrollment rights and puts prohibitions against discrimination or increased premiums due to a person's health
status. You can learn more about HIPPA and the other rights it provides workers by visiting the U.S. Department of Labor's site at
http://www.dol.gov/ebsa/newsroom/fshipaa.html.
At USA-HealthInsurance, we seek to keep our clients informed of their rights and benefits when it comes to health insurance. Whether it's educating you on a
particular policy or on HIPPA compliance, we want to make sure you stay informed. If you're currently looking for health insurance for you or your family,
you can count on our account representatives to search out the best coverage options available in your state. As an insurance agency, we have access to plans
from top health insurance providers across the country, and we pass our knowledge on to you. To get a free quote for insurance in your area, simply give us a
call at 1-800-831-3270.
HIPPA Defined:
The Health Insurance Portability and Accountability Act (HIPAA) offers protections for millions of American workers that improve portability and continuity of health insurance coverage.
HIPAA Protects Workers And Their Families By:
- Limiting exclusions for preexisting medical conditions (known as preexisting conditions)
- Providing credit against maximum preexisting condition exclusion periods for prior health coverage and a process for providing certificates showing periods of prior coverage to a new group health plan or health insurance issuer
- Providing new rights that allow individuals to enroll for health coverage when they lose other health coverage, get married or add a new dependent
- Prohibiting discrimination in enrollment and in premiums charged to employees and their dependents based on health status-related factors
- Guaranteeing availability of health insurance coverage for small employers and renewability of health insurance coverage for both small and large employers
- Preserving the states’ role in regulating health insurance, including the states’ authority to provide greater protections than those available under federal law
Preexisting Condition Exclusions
- The law defines a preexisting condition as one for which medical advice, diagnosis, care, or treatment was recommended or received during the 6-month period prior to an individual’s enrollment date (which is the earlier of the first day of health coverage or the first day of any waiting period for coverage)
- Group health plans and issuers may not exclude an individual’s preexisting medical condition from coverage for more than 12 months (18 months for late enrollees) after an individual’s enrollment date
- Under HIPAA, a new employer’s plan must give individuals credit for the length of time they had prior continuous health coverage, without a break in coverage of 63 days or more, thereby reducing or eliminating the 12-month exclusion period (18 months for late enrollees)
 Or call Toll Free: 1-800-831-3270 , contact or email us!
Creditable Coverage
- Includes prior coverage under another group health plan, an individual health insurance policy, COBRA, Medicaid, Medicare, CHAMPUS, the Indian Health Service, a state health benefits risk pool, FEHBP, the Peace Corps Act, or a public health plan
- Certificates Of Creditable Coverage
- Certificates of creditable coverage must be provided automatically and free of charge by the plan or issuer when an individual loses coverage under the plan, becomes entitled to elect COBRA continuation coverage or exhausts COBRA continuation coverage. A certificate must also be provided free of charge upon request while you have health coverage or anytime within 24 months after your coverage ends
- Certificates of creditable coverage should contain information about the length of time you or your dependents had coverage as well as the length of any waiting period for coverage that applied to you or your dependents
- For plan years beginning on or after July 1, 2005, certificates of creditable coverage should also include an educational statement that describes individuals' HIPAA portability rights. A new model cerfiticate is available on EBSAs Web site.
- If a certificate is not received, or the information on the certificate is wrong, you should contact your prior plan or issuer. You have a right to show prior creditable coverage with other evidence — like pay stubs, explanation of benefits, letters from a doctor — if you cannot get a certificate
Special Enrollment Rights
- Are provided for individuals who lose their coverage in certain situations, including on separation, divorce, death, termination of employment and reduction in hours. Special enrollment rights also are provided if employer contributions toward the other coverage terminates
- Are provided for employees, their spouses and new dependents upon marriage, birth, adoption or placement for adoption
Discrimination Prohibitions
- Ensure that individuals are not excluded from coverage, denied benefits, or charged more for coverage offered by a plan or issuer, based on health status-related factors
Or call Toll Free: 1-800-831-3270 , contact or email us!
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