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Health Insurance Portability and Accountability Act of 1996 (HIPAA)

The Health Insurance Portability and Acccountability Act or better know as (HIPAA) requires various changes to individual health insurance plans. In some states, the insurer must guarantee issue such insurance plans to eligible persns who lose there coverage under a group health plan. Such persons do not have to satisfy another pre-existing condition limitation. The new insurer may require copies of a certificate of creditable coverage to determine how to apply the pre-existing condition limitation. Eligible individuals are guarantee issue to either a health plan or a state - sponsored plan.

 

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An eligible person means a person who meets all the folling requirements:

  • Has a total of 18 or more months of continuous creditable coverage.
  • Most recent creditable coverage was under a group health plan.
  • Is not eligible for coverage under Medicare or Medicaid.
  • Was not terminated for nonpayment of premiums, fraud, or intentional misrepresentation of material fact.
  • Has elected continuation coverage under COBRA or a similar state program, and has exhausted or will soon exhaust this coverage.
  • Is not covered by another policy.
  • Has had less than a 63-day break in coverage from the most recent group plan.

Creditable coverage includes health insurance coverage and other health coverage, such as coverage under other group health plans, short term medical coverage, Medicaid, Medicare, Military sponsored health care, and similar health plans. Creditable coverage does not include accident only coverage, long term care coverage, liability or workers compensation insurance, automobile medical payment insurance, or other similar insurance.

 

 
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