What does HIPAA eligibility mean?
To be HIPAA eligible, a person must have exhausted any COBRA coverage or continuation coverage that was available to them after leaving their previous group health plan. This would include the Federal Employees Health Benefits Program (FEHBP), FEHBP Temporary Continuation of Coverage and state continuation options. If COBRA, FEHBP or continuation coverage was not available, this rule does not apply. In addition, a person must have 18 months of creditable coverage, with the most recent coverage being under an employer sponsored group health plan. COBRA coverage is considered coverage under an employer sponsored group health plan. Most recent coverage is also acceptable if it was under a government plan, a church health plan, or a health benefit plan offered in conjunction with either of these plan types. You do not 18 months of coverage under your most recent plan, as long as you can prove 18 months of continuous coverage from one or more creditable types of coverage. In addition to the above criteria, in order to be HIPAA eligible, you may not have had a lapse in coverage greater than 62 days. You may also not be eligible for Medicare, Medicaid or other group health plan coverage through another employer or the employer of a spouse or domestic partner. You may not have other health insurance coverage in effect and any prior health insurance coverage may not have been cancelled due to failure to pay your premium or from a fraudulent act by you. If you meet this criteria, and are unable to obtain standard issue individual health insurance due to a pre-existing medical condition, there are guarantee options available to you. These options vary from state to state, so you may need to contact your State Department of Insurance, or visit or State Health Insurance Resource section for more information about the options in your state. 2 CommentsLeave a comment |
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What does HIPAA eligibility mean?
HIPAA is an acronym for the Health Insurance Portability and Accountability Act of 1996. Under this federal law, certain rights must be given to any person applying for health insurance, if that person meets specific criteria. If a person meets these criteria, they must be offered guaranteed issue coverage and may not have pre-existing medical condition exclusionary periods placed on their new health insurance policy. Every state must offer some type of guaranteed issue HIPAA option to any person that meets the HIPAA eligibility criteria.
Should I be focused on not losing HIPAA eligibility when considering buying short term health insurance? I graduated from college not long ago and I am now in the market for some short term health insurance. I have been told that I should reconsider, as one of the drawbacks of short term health insurance is that I will become ineligible for HIPAA, which as I understand covers preexisting conditions. I don\’t actually have any preexisting conditions as far as I know, so does this imply that I can go right ahead and purchase short term health insurance? Or could there be reason for me to save my HIPAA eligibility for the future. How long am I actually eligible for HIPAA?
Comment by Jacob — June 7, 2009 @ 12:46 am
Yes!
Buying short-term health insurance or accepting a “conversion plan” will cause you to lose eligibility for HIPAA — of course, waiting 62 days will also cause you to lose yor HIPAA eligibility. Once it’s gone, you can be required to undergo a physical exams and medical background checks before being covered, and you can be denied coverage for pre-existing conditions. Such denial can sometimes happen retroactively, too if the insurance company decides, years from now (once you have a catastrophic illness and made some large claims, for instance), that you failed to disclose some minor historical illness or were not thorough enough in giving them your medical history when you orgiginally applied for coverage.
Comment by Davi — June 17, 2009 @ 7:57 am