HIPAA
HIPAA Protects Workers And Their Families By
Limiting exclusions for preexisting medical conditions (known as preexisting conditions).
Providing credit against maximum preexisting condition exclusion periods for prior health coverage and a process for providing certificates showing periods of prior coverage to a new group health plan or health insurance issuer.
Providing new rights that allow individuals to enroll for health coverage when they lose other health coverage, get married or add a new dependent.
Prohibiting discrimination in enrollment and in premiums charged to employees and their dependents based on health status-related factors.
Guaranteeing availability of health insurance coverage for small employers and renew-ability of health insurance coverage for both small and large employers.
Preserving the States' role in regulating health insurance, including the States' authority to provide greater protection than those available under Federal law.
Preexisting Condition Exclusions
The law defines a preexisting condition as one for which medical advice, diagnosis, care, or treatment was recommended or received during the 6-month period prior to an individual's enrollment date. "Enrollment date" is defined as the first day of health coverage or the first day of any waiting period for health coverage, which ever comes first.
Group health plans and issuers may not exclude an individual's preexisting medical condition from coverage for more than 12 months (18 months for late enrollees) after an individual's enrollment date.
Under HIPAA, a new employer's plan must give individuals credit for the length of time they had prior continuous health coverage, without a break in coverage of 63 days or more, thereby reducing or eliminating the 12-month exclusion period (18 months for late enrollees).
Includes prior coverage under another group health plan, an individual health insurance policy, COBRA, Medicaid, and Medicare.
Certificates Of Creditable Coverage
Certificates of creditable coverage must be provided automatically and free of charge by the plan or issuer when an individual loses coverage under the plan, becomes entitled to elect COBRA continuation coverage or exhausts COBRA continuation coverage. A certificate must also be provided free of charge upon request while you have health coverage or anytime within 24 months after your coverage ends. Certificates of creditable coverage should contain information about the length of time you or your dependents had coverage as well as the length of any waiting period for coverage that applied to you or your dependents. If a certificate is not received, or the information on the certificate is wrong, you should contact your prior plan or issuer. You have a right to show prior creditable coverage with other evidences, such as pay stubs, explanation of benefits, or letters from a doctor.
http://www.dol.gov/ebsa/newsroom/fshipaa.html
