Articles
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Key Points of the Health Insurance Portability and Protection Act of 1996 HIPPA significantly limits the circumstances under which a health insurance plan may deny coverage based upon a pre-existing condition. A plan may only impose a pre-existing condition exclusion that relates to a condition for which treatment was received within six months of the enrollment date. The exclusion is only in effect for twelve months after the enrollment date, and the individual receives credit for previous coverage. HIPPA also protects individuals previously covered by group health insurance plans who are now in the individual market. The individual must have been a member of a group health plan for eighteen or more months, must not be eligible for coverage under another health plan, must not have had prior coverage terminated due to nonpayment of premiums or fraud, must have elected COBRA continuation coverage if such coverage was offered, and must have exhausted the COBRA coverage. Under HIPPA, a group health plan may not deny coverage or charge higher premiums based on certain health status-related factors such as medical condition, claims experience, receipt of health care, medical history, genetic information, evidence of insurability, and disability. Finally, a health insurer may only discontinue coverage for nonpayment of premiums, fraud, violation of participation or contribution rules, termination of coverage in the market, movement outside the service area, if association membership ceases, or if the particular type of coverage is discontinued or all coverage is discontinued. § |
