Brought to you by Health Insurance Choice, your source for Free Health Insurance Quote To understand if and how HIPAA may help you, there are five steps you should take. These steps generally mean you need to: - Understand the different types of health insurance and group health plan coverage that are affected by HIPAA;
- Evaluate the impact of a preexisting condition exclusion that you have which may trigger the need for HIPAA's limited protections;
- Determine how much - if any - creditable coverage you have;
- Understand the other HIPAA coverage protections you have; and
- Know where to go for more information if you have questions.
Step 1: Understand the Various Types of Health Coverage Before you can understand how HIPAA may help protect your health coverage, you must understand what the various types of health coverage are. This is important because the law provides different protections depending on the type of health coverage you have or wish to apply for. Types of Coverage HIPAA generally applies to the following three types of coverage: - Group Health Plans. A group health plan is health coverage sponsored by an employer or union for a group of employees, and possibly for dependents and retirees as well. To understand your rights, you will need to know the following things about your group health plan.
- Does a State or local governmental employer sponsor the plan?
- Does a church or group of churches sponsor the plan?
- Does the plan cover fewer than two current employees?
- Does a small employer or a large employer sponsor the plan?
- Is the plan an insured plan that purchases health insurance coverage from an HMO or other health insurance issuer, or is it a self-insured plan?
- Individual Health Insurance. Individual health insurance coverage is insurance coverage that is sold by HMOs or other health insurance issuers to individuals who are not part of a group health plan. Even though health coverage might be provided through an association or other group, such as groups of college students or self-employed individuals, it is still considered to be "individual" health insurance if it is not provided through a group health plan.
- Comparable Coverage through a High-Risk Pool . Some States have set up high-risk pools to provide health coverage for people who cannot otherwise obtain health insurance coverage in the individual market
Eligibility for HIPAA Protections If you are not currently covered by a particular type of plan or insurance, you need to determine what you may be eligible for. - Your eligibility to enroll in a group health plan is determined by the rules of the group health plan and the contract terms of any insurance purchased by an insured plan.
- Your eligibility to have HIPAA guarantee you the right to purchase individual health insurance coverage (which, in some States, will be through a high-risk pool) depends on your ability to meet ALL of the following requirements:
- You have at least 18 months of creditable coverage without a significant break in coverage - a period of 63 or more days during all of which you had no coverage. If you get coverage by midnight of the 63rd day, you have not incurred a significant break;
- Your most recent coverage must have been through a group health plan (through your or a family member's employer or union);
- You are not eligible for coverage under any other group health plan;
- You are not eligible for Medicare or Medicaid;
- You do not have other health insurance;
- You did not lose your insurance for not paying the premiums or for committing fraud; and
- You accepted and used up your COBRA continuation coverage (See page 12 for more details) or similar State coverage if it was offered to you.
If you meet these requirements, then you become a HIPAA eligible individual . Once you know what kind of health care coverage you have, or would like to apply for, you can begin to understand how HIPAA may protect you and your family. HIPAA Basics Part 2 |
