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eLearning Series:
Your Most Popular Insurance Questions
Answers For Health and Home
Insurance
( 50 articles
in this series )
HIPAA (Health
Insurance Portability
& Accountability Act): What is
it?
HIPAA, an acronym for what is also known as
the Health Insurance Portability and Accountability Act, is
a piece of legislation that was passed under the title “Kennedy-Kassebaum
Act” in 1996. It aims to aid workers who may have lost
a job with an employer-funded health insurance program, and
who deal
with healthcare needs, especially if these needs may identify
them as otherwise uninsurable due to pre-existing conditions
or serious health problems. While it may appear to be a confusing
jumble of letters, HIPAA is an important benefit to workers
who need health coverage and just started a new job, workers
who have medical needs and fear a loss of existing health coverage,
workers who change employers and thus stand to face an interruption
in employer funded health insurance plans, and also workers
who seek to purchase a health insurance policy independent
of an employer.
These
benefits are accomplished by HIPAA designed limitations
on the designation of pre-existing condition exclusions. In
addition to the foregoing, HIPAA forbids insurance carriers
to inflate premiums for perceived poor health risks, either
the individual seeking insurance, or a dependant of the eligible
individual. Subsequently, insurance carriers are no longer
able to refuse policy renewals in light of paid or submitted
claims for coverage.
While these benefits are of tremendous helps to individuals
who have found themselves with medical needs and are simultaneously
transitioning in their workplace, HIPAA very specifically
does not obligate employers to offer health care coverage for
employees,
and their families. Additionally, while it improves the ability
of an individual to receive insurance coverage, it does not
guarantee the coverage, nor does it regulate the exact dollar
amounts an insurance company will charge an individual for
coverage. While HIPAA does limit the pre-existing condition
exclusions, it does not define the specific benefits an insurance
company is required to offer. In addition to the foregoing,
it is noteworthy that while the list of pre-existing conditions
that may be recognized is decreased, it is not eliminated!
For
example, if a worker receives employer sponsored preferred
provider organization health insurance on January 1st, 2005,
and then on January 2nd, 2006 decides to switch to another
health plan the employer offers, perhaps a health maintenance
organization, no pre-existing condition exclusion may be applied
since 12 consecutive months of coverage have been fulfilled.
The most noteworthy constant in HIPAA rulings is the fact that
pregnancy is never considered a pre-existing condition but
must always be covered by an insurance company. Please note
that HIPAA is not a panacea for spotty insurance coverage!
If a worker’s insurance history evidences long breaks in applicable
coverage, i.e. at least 63 consecutive days without insurance
coverage, HIPAA protection will be lost. Thus, a worker will
be wise to accept COBRA coverage when available. If a worker
is indeed eligible for COBRA, HIPAA coverage will not be available
until COBRA benefits have been exhausted.
Since its passage, HIPAA has been amended with the Mental
Health Parity Act of 1996 (MHPA). Very specifically, this piece
of legislation precludes group health plans from enacting yearly
dollar limits on mental health benefits that are lower than
annual dollar limits for covered medical benefits. The MHPA
does not order insurance plans to specifically offer mental
health benefits, and only regulates those plans that actually
offer this coverage. Another amendment to HIPAA is the Newborns'
and Mothers' Health Protection Act of 1996 (NMHPA) which regulates
the amount of time a new mother and her infant you are covered
for a hospital stay following childbirth. The final amendment
occurred with the WHCRA (Women's Health and Cancer Rights Act)
of 1998. This protection is designed very specifically for
cancer patients who elect to undergo breast reconstruction
surgery in connection with a mastectomy. It is important to
understand that the WHCRA does not order health plans to cover
mastectomies, and only applies to insurance plans that already
do cover this procedure.
HIPAA legislation has greatly increased the affordability
of health care for workers, regardless of their economic backgrounds,
health histories, or even the claim histories of their covered
dependants. Nonetheless, it is not an unlimited safety net,
and individual workers must be cognizant of the limitations
HIPAA does have.
Click here to to view health insurance quotes, compare plans side-by-side and apply for the most affordable health insurance within your budget. I did this myself (June 17, 2011) to change my health insurance policy. Saved me $84 per month (or $1,008 per year). It's my SolveYourProblem recommendation.
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by SolveYourProblem.com : 2005
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