subject: Hipaa And Health Insurance [print this page] We all know the drill when we go to a new physician's office. Provide your health insurance card and ID card for them to copy, fill out contact and emergency information, complete a comprehensive medical history form, and sign the HIPAA form. This last form generally provides you with information as to the privacy of your medical records, and while it is an important part of HIPAA, it is by far not the entire act.
HIPAA, or the Health Insurance Portability and Accountability Act, offers an "umbrella of protection" to consumers. It eliminates the previous fear of changing employers due to the potential loss of health coverage for one's family in more than one way.
This act prevents employers (new or old) from excluding any employee from their group health insurance plan due to pre-existing conditions. It also prohibits any discrimination against an employee or family member based on medical history, any genetic information, and previous claims.
However, HIPAA still makes some provisions to allow for group health insurers to limit pre-existing condition coverage under certain circumstances. If care or advice was provided in the previous six months for a specific condition, it may be excluded from coverage or limited for up to 12 months after enrollment, while all other plan benefits are still in effect. Some plans have much shorter exclusion periods, while others have none at all.
In cases in which a pre-existing condition is eligible for an exclusion period, creditable coverage comes into the picture. Any medical coverage that was obtained for the previous 12 months will be considered creditable coverage, as long as the period between policies was less than 63 days. This coverage is then accounted for on an equitable basis: for every month of creditable coverage, the exclusion period is reduced by one month.
In cases of creditable coverage, proof will be required for it to be counted against the exclusion period. If you are leaving a job, a certificate of creditable coverage may be requested free of charge. In addition, when COBRA or other health insurance coverage ends, you will receive a certificate as well. If one is lost or not received, it may be requested for two years, free of charge, from the insurer.
This act also ensures that employees are able to obtain health insurance from an employer in cases of a significant qualifying event. These include the birth or adoption of a child, death of a spouse, divorce, or loss of previous health insurance. Referred to as special enrollment, this is not subject to the terms of open enrollment, but must be requested within 30-60 days of loss of coverage or qualifying event depending on the particular situation.
As you have seen, there is much more to HIPAA and health insurance than just the privacy of your medical records. Designed to help bridge some of the previous gaps in our health care system, it is just one of the legislative acts that is set on improving health care in our country.
by: Casey Trillbar
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