HIPAA Portability Regulations

Health insurance coverage protections became a legal right as of 1997 when the Health Insurance Portability and Accountability Act, or HIPAA, was instituted. HIPAA regulations enable individuals to remain eligible for health coverage in the event of a job change, a change in health plan or a change in coverage type. In effect, HIPAA regulations make health insurance coverage a "portable" protection.

Regulations for Insurability

• Insurability used to be a dicey prospect whenever a person changed jobs, switched insurance companies or went from group to individual coverage plans. Once HIPAA portability regulations became law, specific guidelines regarding a person's eligibility status make it easier to make changes. Individuals with previous health coverage are considered insurable under HIPAA, which enables a person to change coverage should the need arise, according to the HIPAAps Privacy & Security reference site. Time periods in which a person carried insurance are designated as creditable coverage periods. Creditable coverage periods show insurance companies that adequate medical care was provided and an accurate medical history is available. This provision helps to protect insurers from unknowingly taking on policyholders who fall within high risk categories (see Reference 1).

Regulations for Pre-Existing Conditions

• Under HIPAA portability regulations, individuals with pre-existing medical conditions are still entitled to health insurance coverage provided certain provisions are met, according to the HIPAAps Privacy & Security site. When applying for new coverage, any condition that was treated within six months of a person's enrollment date is considered a pre-existing condition. HIPAA portability regulations give insurance companies the right to invoke an exclusionary period in which no coverage is provided for the pre-existing condition. The length of an exclusionary period is based on the length of continuous creditable coverage a person has prior to enrolling in a new plan. Continuous creditable coverage allows for breaks in coverage provided they don't exceed 63 days. Any coverage prior to a 63-day break cannot be credited towards an exclusionary period. The maximum length for an exclusionary period is 12 months, so someone who has nine months worth of creditable coverage would have a three-month exclusionary waiting period before coverage can be applied towards a pre-existing condition (see Reference 1).

Special Enrollments

• According to the United States Department of Labor, special conditions for eligibility may apply in cases where a person is switching from group to individual coverage or when someone chooses not to apply for group coverage during the official enrollment period. Individuals unable to access group health coverage insurance can qualify for individual coverage provided they carried group coverage for a minimum of 18 months prior to applying. HIPAA portability regulations also guarantee access to individual polices or state-run, high-risk insurance plans in cases where a person is ineligible for COBRA, Medicare and Medicaid and is unable to apply for group health coverage.

  Individuals who decide not to enroll for group coverage during an enrollment period may already be covered through a spouse or parent's plan. If for some reason, this coverage is no longer available individuals can still obtain group coverage through a special enrollment process under HIPPA regulations. Special enrollment processes also apply in cases where a person marries, has a child or adopts a child (see Reference 2).