Health Insurance & Patients' Rights

The delineation between patient's rights and the coverage offered by health insurance carriers has been difficult to determine. The U.S. government has addressed this issue by enacting federal legislation to define patient rights and insurance company boundaries.

ERISA

• The Employee Retirement Income Security Act (ERISA) became federal law in 1974. According to the U.S. Department of Labor, ERISA outlines minimum standards for retirement plans and health benefit plans as they pertain to private companies. It includes life and disability insurance.

COBRA

• COBRA extends health insurance coverage to protect employees facing job changes.

  In 1985, the government added new federal regulations to ERISA under the Consolidated Omnibus Budget Regulation Act (COBRA). Under COBRA, an employee must work for an employer who has at least 20 employees. If employees quit, are fired or lose hours, they can continue insurance coverage--if the employee pays--for up to 18 months.

HIPPA

• The Health Insurance Portability and Accountability Act (HIPPA) was enacted in 1996. HIPPA expanded healthcare protections for beneficiaries. It limits the options for insurance companies to deny coverage for pre-existing conditions, stops insurance discrimination because of illness, and offers employees opportunities to obtain coverage when their individual or family status changes.

Patient Protection

• The Affordable Care Act stops insurance companies from suddenly stopping coverage.

  The Affordable Care Act continued to define patient's rights under insurance plans. HealthReform.gov, a patient advocate site, reports this law "cracks down on some of the most egregious practices of the insurance industry while providing the stability and the flexibility that families and businesses need to make the choices that work best for them."