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The Health Insurance Portability and
Accountability Act (HIPAA) of 1996
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Table of Contents
1. HIPAA health insurance portability
2. Provisions for group health plans and issuers
3. Health insurance benefits
4. Special enrollment periods
5. Late enrollment
6. Prohibitions against discrimination based on health status factors
7. Limitations on preexisting condition exclusion periods
8. Sample language for preexisting condition exclusion notification
9. Waiting period
10. HIPAA creditable coverage
11. Employees - Certificates of creditable coverage
12. Employers - Certificates of creditable coverage
13. Enforcement
14. Group market rules
15. Guaranteed availability for small group markets
16. Guaranteed renewability in the individual market
17. HIPAA and COBRA
1. HIPAA health insurance portability --- HIPAA makes health insurance portable by
providing rights in three circumstances:
•
When you leave a job where you had group health plan coverage, and move to
another job with group health plan coverage. (This also applies if you are covered
as a dependent of the person who changes jobs.)
•
You lose group health plan coverage, you meet the definition of a HIPAA eligible
individual and you wish to purchase individual health insurance coverage. (For
more information on a HIPAA eligible individual, go to CMS Webpage, Health
Insurance Reform for Consumers
http://www.cms.hhs.gov/HealthInsReformforConsume/
, scroll down to the
Downloads, select “HIPAA Eligibility Criteria for Individual Coverage".)
•
You have individual health insurance coverage or any other type of creditable
coverage, and you enroll in a new group health plan.
Misunderstandings about HIPAA:
•
Portability does not let you keep your current plan or benefits when you change or
lose your job or get a new job.
•
It does not require your new employer or union to provide health coverage.
