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What is HIPAA?

What is HIPAA?

The Health Insurance Portability and Accountability Act, better known as HIPAA, amended the Employee Retirement Income Security Act (ERISA) in 1996, to provide new rights and protections for participants and beneficiaries in group health plans. Understanding this amendment is important to your decisions about future health coverage.HIPAA includes protections for coverage under group health plans that:

  • Limit exclusions for pre-existing conditions;
  • Prohibit discrimination against employees and dependents based on their health status; and,
  • Allow a special opportunity to enroll in a new plan to individuals in certain circumstances.

HIPAA requires that group health plans give credit for prior coverage. You will receive credit for previous healthcare coverage, as long as you do not have a break in credible coverage of 63 or more days. This is called credible coverage. COBRA coverage also counts as credible coverage as long as you do not have a break in coverage of 63 or more days between COBRA coverage and the group health insurance plan.

In other words, as long as you do not go without insurance for 63 days or more, the insurance company cannot enact the pre-existing condition clause. It is important for you to know your benefits and to understand if your treatment needs to be preauthorized by your provider before rendering services.

For additional information on the HIPAA, go to the Department of Labor’s Employee Benefits Security Administration at http://www.dol.gov/ebsa.