How to Understand Your HIPAA Rights

When most of us think of the Clinton Health Care Plan, we remember Hillary Clinton's failed attempt to bring universal health coverage to all Americans. Still, one important reform did become law in 1996, the Health Insurance Portability and Accountability Act or HIPAA. The act protects American's rights to health insurance when we lose or change jobs, get divorced, pregnant or move. Under HIPAA you cannot be denied group health insurance because of your health. It also limits exclusions for pre existing conditions. Here are your most important rights under HIPPA:

Instructions

• 1

  Pre-existing conditions are a misunderstood minefield. HIPAA limits exclusions for preexisting conditions to medical factors for which you received diagnosis or care during the six months before your enrollment period. It can exclude payment for the treatment for preexisting conditions during a period of generally up to twelve months, but can't deny payment for treatment of other conditions. Your new group health plan must notify you in writing that an exclusion will be placed on you, with the length of the intended exclusion. This exclusion period can be reduced if you demonstrate that you have prior coverage that can be credited to you. There is a one to one day reduction in the exclusion period based on the coverage that you have had. If you have had at least a full year of continuous coverage, a group health plan can't deny coverage due to a preexisting condition. The coverage must be continuous, without a break of 63 or more days in a row. If choose not to enroll in your new plan on your eligibility date your new insurance provider can refuse to pay for treatment for pre-existing conditions for up to 18 months after you join the plan.

• 2

  An employee can't be forced to pay higher premiums than others in the same employment category. In fact, HIPPA prohibits discrimination against employees and dependents based on their health.

• 3

  If you or your dependents were covered by a spouse's plan and he or she lost employment, your employer's insurance company must open coverage to you if it does so for other spouses and dependents. Newborn and adopted children can't be excluded for preexisting conditions if they are enrolled within 30 days. Pregnancy is not considered to be a pre-existing condition.

• 4

  You might find yourself in a situation where you've got to purchase your own health insurance. HIPAA gives you a right to buy individual coverage despite your health, if you meet specific requirements: Your most recent insurance was under a group plan. You must have had at least eighteen months of continuous coverage without any 63 day breaks. Your coverage wasn't terminated for non payment or fraud. You aren't eligible for Medicare or Medicaid. You currently have no group health plan coverage available, and have exhausted COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage.

• 5

  HIPAA also enforces your rights of privacy when it comes to your own medical information, requiring your consent for the sharing of information between providers.

• 6

  Know what HIPAA doesn't do. This is a national law. Although some states are moving to require employers to offer group health insurance for their workers HIPAA does not. It doesn't require coverage for spouses or dependants. It doesn't regulate the kind of coverage a company offers and places no caps on premiums.