HIPAA Insurance & Pre-existing Protection Laws

No one wants poor health or a lack of access to proper health care. However, the previous practices of health insurance companies were denial of coverage to applicants considered high-risk with expensive pre-existing medical conditions. Congress recognized the need for regulation within the health care industry, passing landmark laws such as the Health Insurance Portability and Accountability Act and the Patient Protection and Affordable Care Act to make it easier for all Americans to obtain health insurance without discrimination.

HIPAA

• HIPAA provides special health insurance discrimination protection to workers with a health policy through an employer's plan. The law restricts health insurers from denying a worker coverage because of a pre-existing condition. Under HIPAA, insurers must provide benefits for any worker's pre-existing condition that wasn't treated by a medical professional during the six months prior to applying for insurance. If the employee did seek medical treatment or diagnosis during those six months, the insurer can exclude pre-existing conditions from coverage for a period of up to 12 months, or 18 months for late-enrollee employees.

Patient Protection and Affordable Care Act

• In 2010, the Patient Protection and Affordable Care Act reformed the rules surrounding health insurance and coverage of pre-existing conditions. By January 1, 2014, when the law goes fully into effect, no health insurance applicant will be denied insurance coverage because of a pre-existing condition. Part of the law became effective in 2010, however, when the law made it illegal to deny children under age 19 health insurance because of a pre-existing health condition.

PCIP

• Adults suffering from pre-existing conditions do not have to go without health insurance coverage until 2014. The federal government, as well as several U.S. states, offers a pre-existing condition insurance pool, or PCIP, for individuals who cannot obtain private coverage for a health condition. The plans provide coverage for both an individual's pre-existing condition and other comprehensive care as well. The PCIP doesn't charge higher premiums for pre-existing conditions, and to qualify, an applicant need only be a U.S. citizen with a pre-existing condition and without coverage for the prior six months.

Disability

• Uninsured individuals living with permanent disabilities may qualify for Medicaid insurance. According to the Centers for Medicare and Medicaid Services, Medicaid pays medical providers for services provided to individuals deemed medically needy. To qualify for Medicaid disability insurance, an applicant must have be blind or have a permanent disability, as well as meet state income requirements. Approved applicants can receive coverage benefits immediately, and benefits may be retroactive for up to three months prior to applying for Medicaid.