HIPAA (Health Insurance Portability and Accountability Act of 1996)

HIPAA (Health Insurance Portability and Accountability Act of 1996)

• Limits exclusions for pre-existing medical conditions in group health plans to a maximum of 12 months (18 months for late enrollees).
• A pre-existing medical condition is one in which medical advice, diagnosis, care or treatment was recommended or received during the 6 month period prior to an individualÕs enrollment date.
• HIPAA limits exclusions for pre-existing medical conditions if you have had continuous coverage without a break in insurance coverage for 63 days or more.
• Individuals with a history of prior health care coverage (63 days or less) will be able to reduce the exclusion period by using creditable coverage. Creditable coverage can be used to offset a pre-existing condition exclusion period.
• Creditable coverage includes participation in a group health plan, COBRA continuation coverage, Medicare, Medicaid and coverage through an individual health insurance policy.
• Also prohibits employers who offer group plans from denying or dropping coverage based on an employeeÕs medical status.
• Prohibits discrimination in enrollment and in charged premiums charged to employees and their dependents based on health status-related factors.

Employment Benefits Security Administration (EBSA)United States Department of Labor

866-444-3272 (EBSA) Website

EBSA has benefit advisors available to answer questions and provide assistance about health benefits laws. Contact EBSA directly for more information about COBRA and HIPAA.

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