When you leave a job you may be concerned about continuation of your health insurance coverage. If you have a preexisting health condition you may worry that you will be denied coverage by your new employer's health insurance issuer. Or, if it takes you a while to find a new job, your new employer doesn't offer health coverage, or if you decide to become self employed, you may worry that you won't be able to purchase an individual health insurance policy. Here are some facts about the Health Insurance Portability and Accountability Act that may ease your worries. The information here is very general and only attempts to help you get a better understanding of the Health Insurance Portability and Accountability Act. For more in-depth information, please see the Centers for Medicaid and Medicare Web Site.
HIPAA and Group Health Insurance
- Under HIPAA you cannot be denied group health insurance because of any health factors.
- You can be denied coverage if you don't meet the eligibility requirements of your employer. Eligibility requirements may be based on the number of hours you work or whether you are an hourly or salaried employer.
- As a new employee you may have to wait a period of time before you can enroll in the health insurance plan. This is called a waiting period if it imposed by the employer, or an affiliation period if it imposed by a managed care organization.
- An employer can require that you must be at work on the day your health coverage is to begin unless you're absent due to a health factor. An employer can delay your coverage if you haven't yet begun work.
- If you or your dependents are covered under your spouse's insurance plan and he or she becomes unemployed, your employer's insurance company (if it provides coverage to spouses and dependents) must allow for special enrollment. The same applies if you need to add a dependent, i.e. the birth or adoption of a baby or marriage.
- If you have at least 12 months of continuous creditable coverage, a group health plan can't apply preexisting condition exclusions to your coverage. Creditable coverage includes most kinds of health insurance except health insurance that you had before a significant break in coverage (63 or more days in a row without health insurance coverage). During a preexisting condition exclusion period your insurer will not pay for treatment related to a preexisting condition but must pay for unrelated treatment.
- One employee can't be required to pay higher premiums than other similarly-situated employees. Similarly situated employees are those in the same employment category.
