HIPAA Law Summary

The Health Insurance Portability and Accountability Act (HIPAA) was signed into law in 1996. It provides rights and protections for individual's health insurance records. HIPAA also ensures that employees have access to insurance after leaving a job and protects people with preexisting conditions from being denied coverage.

Medical Records

• You have the right to access your medical records at any time, and HIPAA laws prevent those without your permission from gaining access to your records. Medical providers must protect your privacy and keep your medical records secure. If your medical file has errors, you can request that your provider correct them. A patient can sign a release form allowing a specific person or company to access his records.

Portability

• Workers who change jobs or health insurance providers need documentation showing previous health insurance to secure new coverage. A Certificate of Credible Coverage lists the name of the previous health insurance company and the dates that coverage began and ended. If you are eligible for COBRA under a former employer's group health plan, the employer must provide a certificate showing your termination date or when coverage ends. You should also receive a certificate for all dependents that were covered by the plan. Under COBRA, you can continue your health insurance coverage for up to 18 months by paying the full cost of premiums formerly paid by the employer.

Special Enrollment

• Individuals who lost health insurance coverage under specific circumstances are eligible for special enrollment. You may enroll for coverage after previously declining it. If you turn down coverage with your employer because you receive insurance through a spouse's plan, but eligibility for that plan ends, you can enroll yourself and dependents in another company's plan. Special enrollment rights also apply to individuals who lose coverage because of separation, divorce, death of a spouse, moving from an HMO's coverage area or a reduction in work hours.

Discrimination

• Under HIPAA, a plan provider or health insurance company cannot deny benefits or charge more based on a person's health issues. Coverage cannot be denied if you do not pass a physical. Medical premiums cannot be increased nor coverage delayed if you or an eligible dependent is in the hospital at the time coverage becomes effective. You cannot be denied coverage because of activities you participate in or past claims.

Preexisting Conditions

• HIPAA prevents employee group health plans from limiting or denying coverage because a new employee has a preexisting condition. A health insurance company can check up to six months of previous medical records to verify preexisting conditions before new coverage begins. A preexisting condition exclusion period is limited to 12 months with new coverage. You will be eligible for coverage to treat all other issues, and only the preexisting condition is excluded. The exclusion does not apply to pregnant women, conditions in newborns or adopted children.