My Rights When Purchasing Health Insurance
When purchasing health insurance, it is important to make sure you know what you’re getting into so that you get the proper coverage and a policy that is affordable.
In the event you acquired your health coverage from a licensed insurer, rest assured that you have the benefit of different important protections.
If you have acquired your coverage from your employer and your company has 20 or more employers, you are eligible to continued coverage by the federal Consolidated Omnibus Budget Reconciliation Act (COBRA).
Many states have a mandated continuation of coverage privilege, whereby the law notes that an employee or member who has been covered under the group policy for a minimum of six months and who loses their insurance for any reason (other than nonpayment of premium) can continue coverage for the fractional policy month remaining plus six months.
With COBRA, in the event you depart your present job, you have the choice to continue your health care coverage for up to a year and a half. You will be required to pay the full premium yourself, even in the event your employer paid a portion of your premium while you were employed and the employer may charge an added, limited administrative fee.
To be an “eligible individual,” you are required to meet the following criteria:
- Individuals must have had a year and a half of continued creditable coverage; with at least the last day having been through a group health policy (coverage is looked at as being continuous if it is not interrupted by a break of 63 or more consecutive days).
- Individuals need to have used up any COBRA group continuation coverage for which they were eligible.
- Individuals must not be eligible for Medicare, Medicaid or a group health policy.
- Individuals must not have other major medical health coverage.
- Individuals must apply for health insurance for which they are determined to be an “eligible individual” within 63 days of losing their prior coverage.
When it comes to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), this limits insurer’s powers to turn down or delay claims, decreases the chances for losing current coverage, makes it easier and less risky to switch health plans, and does not allow insurance discrimination due to health problems.
Among the important HIPAA protections is limits on pre-existing condition exclusions, something that presently prevents millions of individuals from obtaining health insurance.
Insurance companies are not allowed to exclude individuals’ treatments and services tied to medical conditions that existed prior to the beneficiary purchasing the health plan for a period more than one year.
In the event the individual has had continued coverage before acquiring the new plan, there can be no coverage exclusions.