HIPAA



HIPAA - Health Insurance Portability and Accountability Act



Hip Hip Hooray for HIPAA with regard to female preexisting medical conditions. Typically females will make the trip to their physican for regular maintenance and specific health issues unlike our male counterparts who would rather self diagnose and medicate with over the counter products.

Medical Information Bureau

Unfortunately every diagnosis by a licensed physician is reported to the MIB (medical information bureau) which is very much like your personal credit report containing your credit history the MIB contains your health and medical history. With that said there will be preexisting medical conditions reported.

HIPPA - Limited Exclusions

HIPAA includes provisions that limit exclusions for preexisting medical conditions and guarantees renewability and availability of health coverage to certain employees and individuals.

HIPAA is an acronym for "The Health Insurance Portability and Accountability Act". HIPAA is often incorrectly spelled as HIPPA due to a phonetic pronunciation that sounds like Hippopotamus.

The Health Insurance Portability and Accountability Act of 1996 was signed into law on August 21, 1996. This law includes important new protections for millions of working Americans and their families who have preexisting medical conditions or might suffer discrimination in health coverage based on a factor that relates to an individual's health. HIPAA's provisions amend Title I of the Employee Retirement Income Security Act of 1974 (ERISA) as well as the Internal Revenue Code and the Public Health Service Act and place requirements on employer sponsored group health plans, insurance companies and health maintenance organizations (HMOs).

HIPAA includes changes that:

  • limit exclusions for preexisting medical conditions;


  • prohibit discrimination against employees and dependents based on their health status;


  • guarantee renewability and availability of health coverage to certain employers and individuals;


  • protect many workers who lose health coverage by providing better access to individual health insurance coverage.






HIPAA Guidelines

Preexisting Medical Condition Exclusions

Under the plan, a group health plan or a health insurance issuer offering group health insurance coverage may impose a preexisting medical condition exclusion with respect to a participant or beneficiary only if the following requirements are satisfied:

A preexisting medical condition exclusion must relate to a condition for which medical advice, diagnosis, care or treatment was recommended or received during the 6-month period prior to an individual's enrollment date;

A preexisting medical condition exclusion may not last for more than 12 months (18 months for late enrollees) after an individual's enrollment date;

this 12 or 18 month period must be reduced by the number of days of the individual's prior creditable coverage, excluding coverage before any break in coverage of 63 days or more.

Health coverage Benefits for people who want to change jobs?

Currently some employer health plans do not cover preexisting medical conditions. The plan limits the time period of these restrictions so that most plans must cover an individual's preexisting condition after 12 months. Under HIPAA, your new employer's plan will be required to give you credit for the length of time that you had continuous health coverage that will reduce the 12 month exclusion period.

If, at the time you change jobs, you already have had 12 months of continuous health coverage (without a break in coverage of 63 days or more), you will not have to start over with a new 12- month exclusion for any preexisting medical conditions.

Preexisting Condition under HIPAA

A "preexisting condition" is a condition present before your enrollment date in any new health plan.

Under the plan, the only preexisting conditions that may be excluded under a preexisting condition exclusion are those for which medical advice, diagnosis, care or treatment was recommended or received within the 6-month period ending on your enrollment date.

HIPAA - Past Medical Condition

If you had a medical condition in the past, but have not received any medical advice, diagnosis, care or treatment within the 6 months prior to your enrollment date in the plan, your old condition is not a "preexisting condition" for which an exclusion can be applied.

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