HIPAA stands for the Health Insurance Portability and Accountability Act. Passed by Congress in 1996, HIPPA helps to protect your rights to health coverage during events such as changing or losing jobs, pregnancy, moving, or divorce. It provides rights and protections for employers when getting and renewing health coverage for their employees.
The following information highlights the scope of HIPAA in the broadest sense. Keep in mind HIPAA is not an insurance policy.
HIPAA provides rights and protections for both group health plans and individual coverage. These rights and protections address:
- Portability – Whether you can get new health coverage if you want to change coverage
- Availability – Whether health coverage must be offered to you and your dependents
- Renewability – Whether you are able to renew health coverage
Who does HIPAA protect?
HIPAA might protect individuals who experience the following life events:
- Have lost or are changing jobs
- Are recently married or divorced
- Are gaining new dependents through birth or adoption
- Are moving from one State to another
- Have preexisting conditions or other health factors that make it difficult to get health coverage
- Have had health coverage and are now being denied coverage
- Want to renew your health coverage
- Are a small employer and want to buy health coverage for your employees
- Are an employer and want to renew health coverage for your employees
What does HIPAA NOT do?
HIPAA does NOT:
- Require employers to offer health coverage
- Regulate the cost of health coverage
- Regulate the types of benefits that must be offered
- Provide protections when you wish to change from one form of individual coverage to another
HIPAA and Group Health Plans
Important HIPAA rights and protections for group health plans include:
- Limits on preexisting condition exclusions
- Prohibition of discrimination based on health factors
- Requirements for special enrollment opportunities for people who lose other group health coverage or gain new dependents, such as a spouse or a child
- Requirements for certificates of creditable coverage
- Guaranteed availability of group health plans for small employers
- Guaranteed renewal of all group health plans at the option of the employer
HIPAA and Individual Coverage
Important HIPAA rights and protections for individual coverage include the following:
- HIPAA-eligible individuals are guaranteed the right to purchase individual coverage
- Preexisting condition exclusions are not allowed for HIPAA-eligible individuals
- Certificates of creditable coverage are required
- Individual health insurance coverage is guaranteed to be renewed
- Comparable coverage issued through a state high-risk pool
To learn more about HIPAA and other government legislation and programs related to health benefits be sure to go to the Health Care Financial Administration website. If you would like to understand the terms used in the HIPAA legislation like “HIPAA-eligible”, certificates of creditable coverage, state high-risk pool or even how HIPAA defines group health plan vs. individual coverage, click here.
For more detail explanations from an employer or employee’s perspective go to HIPAA Online.