Health Insurance for Individuals, HIPAA, Cobra

HIPAA (Health Insurance Portability and Accountability Act) is a Federal law that does three things:

1) it makes it easier to take your health information with you when you change employers,
2) it sets very strict rules about the privacy of your medical records, and
3) it gives you the right to purchase individual health insurance after you've used up your COBRA benefits (see "COBRA").

Before HIPAA it was often hard to move your medical information from one insurer to another, and there were few safeguards for your privacy. It was also very difficult to obtain insurance after COBRA benefits ran out. HIPAA improved these shortcomings.

If you have been covered by health insurance including COBRA and have exhausted all COBRA/CalCOBRA benefits with no break longer than 63 days, HIPAA gives you the right to buy individual health coverage with few or no limits on pre-existing conditions.

Who is eligible for HIPAA?

In order to qualify as an eligible individual you must meet the following conditions:

You have 18 or more months of prior creditable coverage. Your most recent health care coverage must be under an employer sponsored group health plan, which includes COBRA or Cal-COBRA continuation coverage. This prior 18-month coverage is referred to as "creditable coverage."

All available COBRA or Cal-COBRA continuation coverage has been elected and exhausted. Note: When an employer terminates its existing group health plan entirely, COBRA or Cal-COBRA coverage ends and is considered exhausted.

You are not eligible under a group health plan, Medicare, Medi-Cal, and/or do not have other health insurance coverage.

You did not lose your most recent health coverage due to nonpayment of premium or fraud.

When should an individual apply for a HIPAA policy?

Once COBRA or Cal-COBRA has been exhausted, you have 63 days to file an application to purchase a guaranteed issue HIPAA policy with an insurance company or health plan. All carriers that sell individual health care policies must offer their two most marketed individual plans to HIPAA eligible individuals regardless of your health status. If you accept a conversion policy or a short-term policy after exhausting COBRA or Cal-COBRA, you give up the HIPAA eligibility. It is important to note that a conversion policy is not a HIPAA policy.

When applying for a HIPAA policy, you can present a Certificate of Creditable Coverage from your insurance company or health plan as part of the application process. The Certificate of Creditable Coverage is a written statement from the insurance company or health plan showing the length of time you have been covered. The Certificate can be used as proof of your 18 months continuous creditable coverage when applying for a HIPAA policy.
Who enforces HIPAA?

HIPAA is jointly regulated by the CDI and the DMHC depending upon the type of coverage (indemnity or HMO).

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Health Insurance for Individuals, Families, Seniors, Self Employed and Small Businesses

What's HIPAA?

HIPAA (Health Insurance Portability and Accountability Act) is a Federal law that does three things:

Who is eligible for HIPAA?

When should an individual apply for a HIPAA policy?