Understanding HIPAA Portability Rights & Pre-existing Conditions

HIPAA refers to the federal law created by the Health Insurance Portability and Accountability Act passed in 1996. This law increased the portability of health insurance by limiting coverage exclusions and health-related discrimination.

Pre-existing Condition Exclusion

• A health plan can only exclude pre-existing health conditions that were diagnosed or received medical attention in the six months prior to applying for coverage.

Exclusion Time Period

• For conditions that are excluded from a health plan upon enrollment, HIPAA allows the exclusion to be applied for only 12 months.

Specific Conditions

• Genetic information, pregnancy and medical problems that were present at birth for children cannot be excluded from medical coverage.

Late Enrollment

• Enrollment in an employer's health plan after the first period of eligibility extends the pre-existing exclusion period to 18 months.

Break In Health Coverage

• HIPAA applies to individuals who change health insurance with 63 days or less between coverage. Individually purchased health plans or COBRA coverage can bridge gaps in health coverage caused by unemployment periods.

Special Enrollment

• HIPAA portability is available for individuals who previously declined health coverage. HIPAA eligibility is initiated by the loss of other health insurance and specific life events like divorce or death.