Celiac.com Sponsor (A1):

Celiac.com Sponsor (A1-m):

  • You've found your Celiac Tribe! Join our like-minded, private community and share your story, get encouragement and connect with others.


    • Sign In
    • Sign Up


This topic is now archived and is closed to further replies.


Hipaa And Insurance Coverage

Recommended Posts

Sorry if this is in the wrong place...

I was looking up info about pre-existing conditions and insurance, because I live in constant fear of not being insured. For no good reason, but still, you never know. I found this at about.com here:


HIPAA and Group Health Insurance

*Under HIPAA you cannot be denied group health insurance because of any health factors.

You can be denied coverage if you don't meet the eligibility requirements of your employer. Eligibility requirements may be based on the number of hours you work or whether you are an hourly or salaried employer.

*As a new employee you may have to wait a period of time before you can enroll in the health insurance plan. This is called a waiting period if it imposed by the employer, or an affiliation period if it imposed by a managed care organization.

*An employer can require that you must be at work on the day your health coverage is to begin unless you're absent due to a health factor. An employer can delay your coverage if you haven't yet begun work.

*If you or your dependents are covered under your spouse's insurance plan and he or she becomes unemployed, your employer's insurance company (if it provides coverage to spouses and dependents) must allow for special enrollment. The same applies if you need to add a dependent, i.e. the birth or adoption of a baby or marriage.

*If you have at least 12 months of continuous creditable coverage, a group health plan can't apply preexisting condition exclusions to your coverage. Creditable coverage includes most kinds of health insurance except health insurance that you had before a significant break in coverage (63 or more days in a row without health insurance coverage). During a preexisting condition exclusion period your insurer will not pay for treatment related to a preexisting condition but must pay for unrelated treatment.

*One employee can't be required to pay higher premiums than other similarly-situated employees. Similarly situated employees are those in the same employment category.

HIPAA and Individual Coverage

There are situations in which you might like to or need to purchase your own insurance policy. This may be the case if you can't find a job and any other coverage you have has expired. You may also be hired by an employer who doesn't offer a group health plan or you may decide to become self employed. It is generally not a good idea to go without health insurance. A catastrophic illness can decimate your life savings. Furthermore, if you are without health insurance for 63 or more days, you will lose some of your HIPAA rights and protections. HIPAA-eligible individuals are guaranteed the right to purchase individual coverage.

You are considered HIPAA-eligible if:

*you have had at least 18 months of continuous coverage without any significant breaks

*your most recent insurance was under a group plan

*you aren't eligible for coverage under another group plan

*your coverage wasn't terminated due to non-payment of premiums or insurance fraud

*you aren't eligible for Medicare or Medicaid

*you purchased and exhausted COBRA, Temporary Continuation of Coverage, or State Continuation Coverage, if they were offered to you

What HIPAA Doesn't Do

It doesn't require that employers provide group health insurance for their employees.

It doesn't require a company's health insurance plan to include family or dependant coverage.

It doesn't regulate the coverage group plans offer.

It doesn't regulate premium rates.

Additional Information About HIPAA

A break in insurance coverage of 63 days or more will cause you to lose some of your HIPAA rights and protections.

You can request a free certificate of creditable coverage from your prior insurance carrier; it will state the length of time you were covered by that carrier.

Alright, don't worry even if things end up a bit too heavy

We'll all float on, alright

Well we'll float on good news is on the way...

Share this post

Link to post
Share on other sites

Celiac.com Sponsor (A8):

Celiac.com Sponsor (A8):

That is good to know what the law states.

A friend of mine had to get legal representation for her mother to get treatment for her stage one cancer. By the time the court intervened her mom has stage 3 cancer and has finally started treatment.

Some people on this forum have mentioned having troubles with coverage because of Celiac.



Share this post

Link to post
Share on other sites

That is really good information broken down into a very "reader-friendly" way. Thank you very much. . . . Lynne


Courage does not always roar. Sometimes it is the quiet voice at the end of the day that says, "I'll try tomorrow".

"There's not a word yet, for old friends we've just met. Part Heaven, part space, or have I found my place? You can just visit, but I plan to stay, I'm going to go back there some day." Gonzo, in the Muppet Movie

Share this post

Link to post
Share on other sites