You can find lots of borderline legal discussion of HIPAA coverage online but we wanted to try and simplify the big words down to a simple explanation of how it works from which, you can always go to the deeper side of the pool with more detail. Let's take a look at HIPPA health insurance coverage in California and how it can provide a safety net for those people who are loosing group health insurance. We'll also discuss Health Reform's impact and probably elimination of the need for HIPAA.
HIPAA actually refers to a federal law that
governs many aspects health insurance
portability (the congressional term for being
able to continue health insurance) and privacy
among other items. We'll focus on the
portability side of things. HIPAA coverage may
be available to people on a guaranteed issue
basis (regardless of health) if they meet
certain requirements. The primary scenario where
HIPAA becomes an option is when a person
exhausts Cobra coverage or involuntarily loses
group health insurance (for example...the
company closes or shuts down the group health
plan). A person (or dependents) generally have
be on continuous coverage for 18 months most
recently on a group health plan (regular
employer sponsored health insurance or Cobra)
and involuntarily lose the coverage. For
example, you can't just stop paying your Cobra
premium and cancel that coverage in order to get
HIPAA and it likely wouldn't be advisable
anyway. To take a step back, Cobra is
continuation of group health insurance where you
(as the terminated employee) pay the premium.
You must exhaust Cobra to be eligible for HIPAA
coverage and if you're eligible for a Cal-Cobra
extension of another 18 months, you must exhaust
that as well. HIPAA is designed a plan of last
option and we really can't have other options
available to us. A few key points about HIPAA
coverage for California health insurance.
By law, a California carrier must offer their two most popular individual health plans on a HIPAA basis. You typically have 62 days to elect HIPAA from your last date of eligible group health coverage (including Cobra or Cal-Cobra) to elect HIPAA but the carrier have become more stringent on this in terms of potential effective dates. It used to be that we could choose any effective retro-actively back to the last date of group health insurance but that doesn't seem to be the case. Although we're not sure of what law changed to allow this scrutiny, the carriers are instituting effective date rules based on when they receive the application and required supporting information. You generally have to submit either a HIPAA application or complete the HIPAA information. The bottom line is that you want to get this information in as soon as possible if you need the HIPAA coverage.
Basically, we can't qualify for anything else. When we exhaust Cobra/Cal-Cobra, we generally want to apply for California individual health insurance but that currently requires that we're in good health. If were declined coverage, HIPAA may be our only option and it's generally richer than MRMIP through the State's high risk pool. PCIP, the new Federal pre-existing condition plan requires that you have been uninsured for at least 6 months which does not work for people who are exhausting Cobra/Cal-Cobra and it's hard to recommend going without coverage for 6 months even though the pricing for PCIP is better. Each California health carrier will have their own HIPAA application, brochures, and rates and we don't publish them since they change over time. They are not quoted in our California health insurance quoting engine but they can be emailed you by request. This is just a quick and hopefully understandable overview of HIPAA insurance plans in California so please feel free to run your situation by us. Keep in mind that the need for HIPAA will largely go away Jan 2014 when all individual health plans are guaranteed issue through the Exchange albeit at a higher expected monthly rate.
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