HIPAA – Health Insurance Portability And Accountability Act

by Steve

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) happens to be a law that can directly affect those looking for personal health insurance (Yuma Insurance) – and that have a pre-existing condition.

If this sounds like you, or a member of your family, then you need to be aware of the laws and your legal rights within them.  Having this information can help you to select the right coverage and keep your family safe.

Before this law was passed, if a person had to change jobs, they were often refused coverage under the new employer’s health insurance if there was a pre-existing condition present.  The new insurance company did not want to take on the liability and would deny coverage to the individual.  With only their bottom line in mind, they sought to protect their assets only, and would leave the family vulnerable.


With the passage of HIPAA, insurance companies now are required to honor prior coverage for individuals who did not have a lapse in coverage.  It also protects families by limiting the exclusions for pre-existing medical conditions and provides a process that allows individuals to enroll for health coverage when they lose other health coverage, get married or need to add a new dependent.

HIPAA also prohibits discrimination in enrollment and premiums charged by insurance companies based on health status-related factors.  The law also guarantees availability of coverage for small employers and preserves the states’ role in regulating health insurance.

Preexisting Condition Exclusions

As a definition for “Pre-existing condition” the law states that it is, “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 (which is the earlier of the first day of health coverage or the first day of any waiting period for coverage)*.”

For group health plans, the issuer cannot exclude the individual’s pre-existing condition for more than 12 months after the enrollment date and the new employer’s plan has to 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)*.”

There are also special enrollment rights that are for individuals who have lost coverage due to particular situations, such as: separation, divorce, death, termination of employment or a reduction in hours.  These special rights are provided if the employer contributions toward the coverage are terminated, and are extended to those who need to add dependents because of marriage, birth, adoption or placement for adoption.

Perhaps the most important part of the Act is that it has stopped the discrimination by insurance companies.  It does not allow exclusion from coverage, a denial of benefits or the charging of more money for coverage by the plan or issuer based on health status-related factors.

The HIPAA laws are worth knowing and will supply you with the information you will need when it comes to questioning health insurance companies about their HIPAA policies.

Before you begin your search for any individual health insurance coverage, be sure to study up on the HIPAA laws so that you are aware of the questions to ask and to make sure your personal information will be safe.


Leave a Comment

Previous post:

Next post: