HIPAA

What is HIPAA? — The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) was enacted in August 1996 as part of a broad congressional attempt at health care reform.

It mandates that anyone belonging to a group health insurance plan must be allowed to purchase health insurance within an interval of time beginning when the previous coverage is lost. The law protects employees, especially those with long term health conditions who may be reluctant to leave jobs because they are afraid pre-existing condition clauses will limit coverage of any such conditions under a new insurance plan, from losing health insurance due a change in employment status.

The “Administrative Simplification” provisions of HIPAA required the Department of Health and Human Services (“HHS”) to:

1. Create privacy standards to protect personal health information,
2. Adopt national standards for format and content of electronic health care transactions (called “EDI” for electronic data interchange transactions) and
3. Create security standards to protect the electronic transmission of personal health information.

For more information:
www.dol.gov/ebsa
www.hipaacomply.com
ww.hhs.gov/ocr/privacy/index.html

Maryland:
• If you lose your group health insurance and meet other qualifications, you will be HIPAA eligible. If so, you can buy an individual health insurance policy from the Maryland Health Insurance Plan (MHIP). You will not face a new pre-existing condition exclusion period if you are HIPAA eligible.
• If you are not HIPAA eligible but have had difficulty obtaining an affordable individual health insurance policy because of your health condition, you may also be eligible under MHIP. You may be subject to a 2 month pre-existing condition exclusion period.

Virginia:
• If you are HIPAA eligible, you are guaranteed the right to buy any individual health insurance policy that an insurance company sells in Virginia. However, an insurance company may charge you significantly higher premiums due to your health status, age, or other factors.
• All Virginia residents are guaranteed the right to buy individual health insurance from either Anthem Blue Cross Blue Shield or CareFirst Blue Cross Blue Shield, depending on where you live. This is called guaranteed issue.

Note: Each state varies in terms of regulations.
Please call us for details: 866-330-0195.