Introduction
The Health Insurance Portability and Accountability Act (HIPAA),
signed into law on Aug. 21, 1996, offers protection for
millions of American workers by improving portability and
continuity of health insurance coverage.
HIPAA protects workers and their families by:
- Limiting exclusions for preexisting medical conditions;
- Providing credit for prior health coverage and a process
for providing certificates concerning prior coverage to a new
group health plan or issuer;
- Providing rights that allow individuals to enroll for
health coverage when they lose other health coverage or add a
new dependent;
- Prohibiting discrimination in enrollment and in premiums
charged to employees and their dependents based on health
status-related factors; guarantees availability of health
insurance coverage for small employers and renewability of
health insurance coverage in both the small and large group
markets; and preserves the states’ role in regulating health
insurance, including the states’ authority to provide greater
protections.
Preexisting Condition Exclusions
The law defines a preexisting condition as one for which
medical advice, diagnosis, care, or treatment was recommended
or received during the six-month period prior to an
individual’s enrollment date. Most group health plans may not
exclude an individual’s preexisting medical condition from
coverage for more than 12 months (18 months for late
enrollees) after an individual’s enrollment date. The HSU plan
defines a preexisting condition as "A condition for which
medical advice, diagnosis, care, or treatment was recommended
or received during the six months before the the effective
date of coverage.
Under HIPAA, a new employer’s plan must give individuals
credit for the length of time they had continuous health
coverage, thereby reducing the 12-month exclusion period.
Individuals who have 12 months of continuous health coverage -
without a break in coverage of 63 days or more - do not have
to start over with a new 12-month exclusion for any
preexisting conditions.
Creditable Coverage
Creditable coverage includes prior coverage under another
group health plan, an individual health insurance policy,
COBRA, Medicaid, Medicare, military coverage, or a public
health plan.
Certificates of Creditable Coverage
If you are a new HSU employee and have medical insurance
where you have been working, ask them to provide you with a
certificate of creditable coverage. You will be asked
for this during your orientation at HSU. Plan
administrators must automatically provide a certificate of
creditable coverage when an individual loses coverage under
the plan or exhausts COBRA continuation coverage. Certificates
must be provided, if requested, before losing coverage or
within 24 months of losing coverage.
Special Enrollment Rights
Special enrollment rights are provided for individuals who
lose their coverage in certain situations. or who become a new
dependent through marriage, birth, adoption or placement for
adoption. Please note that HSU does not have what is
referred to as "open enrollments" or annual enrollments.
During orientation, you will be provided information about our
medical insurance. You will have 30 days from your
employment date to decide if you want to participate in our
plan.
Discrimination Prohibitions
Individuals can not be excluded from coverage, or charged
more for benefits offered by a plan or issuer, based on health
status-related factors.
Questions
If you have questions about our insurance eligibility,
contact the Human Resources Office at extension 1507.
Links
Return to Human Resources Web Site
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