What are my rights to health insurance portability with HIPAA?

HIPAA might make it easier to get an individual health policy if your employer decides to drop group health coverage. These kinds of scenarios happen all the time in life, and when you face them, you must be prepared.

You will probably be able to purchase an individual health plan without the threat of exclusions for pre-existing conditions under (HIPAA). However, you must qualify as an “eligible individual” in order to do so.

There are some states that will require all companies offering individual health plans in that state to sell you coverage, if you qualify for the individual health coverage under HIPAA. You can find out the rules in your state’s insurance department.

In order to qualify as an individual under HIPAA, you must:

• Not have other health insurance coverage

• Not be eligible for coverage under a group health plan (spouse’s plan, too), Medicaid or Medicare.

• Under COBRA or a similar state law, have selected and exhausted any option for continuation of coverage that was available to you in your previous plan.

• Contain at least 18 months of continuous creditable coverage

• Have been covered under a governmental plan, church plan or a group health plan

• Have not lost your recent health coverage because of non-payment of premiums or fraud

Deborah Chollet, a senior fellow at Mathematica Policy Research, claims that when it comes to premiums for individual policies, HIPAA has two shortcomings, “One is it didn’t say anything about how that coverage would be priced. Even if I am leaving the group market, I have lost coverage in the group market for reasons I do not control, HIPAA did not constrain insurers in any way for how they price you coming in”.

Chollet adds, “The other thing that HIPAA did not do is make the world safe for people who live in the individual market. If I am in the individual market, I can easily get trapped in a policy. I may have gotten into this policy, but I decided the rates have gone up so I want to shop around. I want to look for other coverage. I don’t have guaranteed issue. I have no guarantees that I can find another insurer who will accept me. If I have a guarantee, it comes from the state. It doesn’t come from any federal guarantees”.