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Confused about Hipaa
Mar 26, 2012

It's my understanding that if one has creditable insurance and does not have an insurance lapse of more than 62 days, insurance companies must offer you insurance coverage irregardless of pre-existing conditions. Yet in a recent Sacramento newspaper, a writer claimed that his COBRA policy was ending and he was denied coverage by several insurance companies due to pre-existing conditions. What's the real story?

Response from Mr. Chambers

Like most things in life, there is the law and the real world.

First the law. HIPAA states that: 1. If you lose your health insurance; AND 2. You had health insurance without a lapse of more than 63 days for at least 18 months; AND 3. Your last health coverage was group health coverage provided by an employer; AND 4. You have taken COBRA Continuation coverage as long as legally possible; THEN You have 63 days from the end of your COBRA to apply for and purchase an individual health insurance policy as provided under HIPAA and you cannot be refused coverage.

The law provides that each state can decide whether that individual policy is part of one high risk pool the state operates OR the state can require every insurance company writing health insurance in that state must offer two specific plans, the two largest plans by premium volume. In those states that require all companies to participate, which California is one, you will find that most of the plans are similar and the deductibles are usually $1,000 or more.

The writer you mentioned in the Sacramento paper probably called the customer service line of an insurance company and requested coverage without mentioning HIPAA so the clerk just sent out their regular application including health questions, and the writer, not knowing better, filled it out and sent it in.

When applying for coverage under HIPAA, you must be very specific in your request and you should NOT have to answer any questions about your health.

Call an insurance company that writes individual health policies in your state and say something like: "I just lost my COBRA coverage and I know I am uninsurable due to pre-existing conditions, but there is a federal law called HIPAA that says I can still buy a health insurance policy as long as I buy it within 63 days of my coverage ending." If the clerk on the line doesn't know what you are talking about, ask for a supervisor until you find someone who understands HIPAA guaranteed coverage.

Or contact an independent insurance agent and ask them in the same manner. Note that because the reimbursement to insurance agents is so low for these policies, not all agents will be enthusiastic about helping you.

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