| Brief Summary: |
The Health Insurance Portability and Accountability Act of
1996, known as HIPAA, includes important new - but limited - protections
for millions of working Americans and their families. HIPAA may:
- Increase your ability to get health coverage for yourself and your
dependents if you start a new job;
- Lower your chance of losing existing health care coverage, whether
you have that coverage through a job, or through individual health
insurance;
- Help you maintain continuous health coverage for yourself and your
dependents when you change jobs; and
- Help you buy health insurance coverage on your own if you lose
coverage under an employer's group health plan and have no other
health coverage available.
Among its specific protections, HIPAA:
- Limits the use of pre-existing condition exclusions;
- Prohibits group health plans from discriminating by denying you
coverage or charging you extra for coverage based on your or your
family member's past or present poor health;
- Guarantees certain small employers, and certain individuals who lose
job-related coverage, the right to purchase health insurance; and
- Guarantees, in most cases, that employers or individuals who
purchase health insurance can renew the coverage regardless of any
health conditions of individuals covered under the insurance policy.
In short, HIPAA may lower your chance of losing existing coverage, ease
your ability to switch health plans and/or help you buy coverage on your
own if you lose your employer's plan and have no other coverage available.
HIPAA generally applies to the following three types of
coverage:
Group Health Plan - Health coverage sponsored by an employer or union
for a group of employees, and possibly for dependents and retirees as
well. To understand your rights, you will need to know the following
things about your group health plan.
- Does a State or local governmental employer sponsor
the plan?
- Does a church or group of churches sponsor the plan?
- Does the plan cover fewer than two current employees?
- Does a small employer or a large employer sponsor the
plan?
- Is the plan an insured plan that purchases health
insurance coverage from an HMO or other health insurance issuer, or
is it a self-insured plan?
Individual Health Insurance. Individual health insurance
coverage is insurance coverage that is sold by HMOs or other health
insurance issuers to individuals who are not part of a group health
plan. Even though health coverage might be provided through an
association or other group, such as groups of college students or
self-employed individuals, it is still considered to be
"individual" health insurance if it is not provided through a
group health plan.
Comparable Coverage through a High-Risk Pool . Some States have
set up high-risk pools to provide health coverage for people who cannot
otherwise obtain health insurance coverage in the individual market .
Click here for the Formal HIPAA Version
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