What Are the Benefits of HIPAA?

HIPAA, or the Health Insurance Portability and Accountability Act, is a federal law that allows citizens access to healthcare coverage after they have exhausted COBRA/continuation coverage. It also protects the confidentiality and use of PMI (personal medical information) from individuals' healthcare records.

• HIPAA protects healthcare consumers.

Significance

• Many healthcare consumers don't know that HIPAA can assist them in purchasing appropriate health insurance coverage if they run out of COBRA (or similar types of continuance coverage) and they no longer have access to any type of group health plan coverage.

Function

• HIPAA prevents employer health insurance plans from limiting or denying coverage to you if you have a preexisting condition by only allowing the new plan to look back at the six months prior to your enrollment date for diagnosed or treated conditions.

Effects

• If you do have a preexisting condition, HIPAA sets limits on how long the exclusion period for coverage can be. As of 2009, the exclusion period is usually 12 months (although in some cases, the period may last 18 months).

Other Care

• However, HIPAA requires that this exclusion only apply to preexisting conditions and protects your rights to receive coverage for other benefits in the health plan (that is, coverage for care apart from what's needed for your preexisting condition).

State Protection

• Your state may have additional protection that works with federally mandated HIPAA. To find out if your state offers additional protection, contact your state's insurance commissioner office.

Patient Rights

• Another benefit of HIPAA is that it protects your PMI--including information in your medical record (written or spoken) and information about your insurance or billing history--and limits how that information may be shared, and with whom.