HIPAA was signed into federal law August 21, 1996. This law includes important new protection for millions of working Americans and their families who have pre-existing medical conditions.
Pre-existing Conditions Exclusions:
Under HIPAA, a group health plan or a health insurance insurer offering group health insurance coverage may impose a pre-existing condition exclusion with respect to a participant or beneficiary only if the following requirements are satisfied:
- Pre-existing condition exclusion must relate to a condition for which medical advise, diagnosis, care or treatment was recommended or received during the 6-month period prior to an individuals enrollment date.
- Pre-existing condition exclusion may not last for more than 12 months (18 months for late enrollees) after an individual's enrollment date.
How does HIPAA help people that currently have group health coverage and who want to change jobs:
If a person is looking to change jobs and had 12 months of continuous group health coverage, no pre-existing conditions clauses will apply with the new health plan.
Certification of Creditable Coverage:
Group health plans and health insurance issuers are required to furnish a certificate of coverage to an individual to provide documentation of the individual's prior coverage.
The certificate must be issued automatically when an individual either loses coverage under the plan or becomes entitled to elect COBRA and when an individual's COBRA continuation coverage ceases.
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