How does HIPAA legislation affect individual coverage?
If an individual meets the definition of a HIPAA-eligible individual (as defined in HIPAA legislation), then that individual is guaranteed availability of individual coverage from a carrier OR state POOL plan (depending on state requirements) that offers such coverage, and a pre-existing condition exclusion cannot be applied to that individual guaranteed coverage. Please refer to the HIPAA section of the Centers for Medicare and Medicaid website at http://cms.hhs.gov/hipaa/ for additional information.
In general when leaving group coverage eligible individuals with prior group coverage can receive guaranteed individual coverage. Each state may implement statutes and regulations to modify the requirements but the modifications must be at least as favorable as the requirements pursuant to HIPAA. HIPAA portability, special enrollment and nondiscrimination rules generally apply to group health plan and health insurance issuers offering group health insurance coverage. In contrast, individual polices of health insurance are subject to HIPAA s individual insurance market rules, which include guaranteed availability, guaranteed renewability and Certificate of Creditable Coverage requirements. Group to individual conversion coverage, is considered individual health insurance coverage. Consequently, the individual market rules generally will apply to such conversion coverage. However, an insurer that offers conversion coverage to former group plan participants but does not otherwise offer co
In general when leaving group coverage eligible individuals with prior group coverage can receive guaranteed individual coverage. Each state may implement statutes and regulations to modify the requirements but the modifications must be at least as favorable as the requirements pursuant to HIPAA. HIPAA portability, special enrollment and nondiscrimination rules generally apply to group health plan and health insurance issuers offering group health insurance coverage. In contrast, individual polices of health insurance are subject to HIPAA’ s individual insurance market rules, which include guaranteed availability, guaranteed renewability and certificate of creditable coverage requirements. Group to individual conversion coverage, is considered individual health insurance coverage. Consequently, the individual market rules generally will apply to such conversion coverage. However, an insurer that offers conversion coverage to former group plan participants but does not otherwise offer c
A37. In general, when leaving group coverage, eligible individuals with prior group coverage can receive guaranteed individual coverage. Terminating employees and their families or members who have exhausted their COBRA benefits may request continued Blue Cross coverage on an individual basis. Blue Cross conversion coverage and Blue Cross individual plans under HIPAA are available upon request to former group members who meet certain requirements. The benefits and cost of these plans may differ from the employee’s plan. Both conversion and HIPAA coverage are available for medical coverage only. HIPAA portability, special enrollment and nondiscrimination rules generally apply to group health plan and health insurance issuers offering group health insurance coverage. In contrast, individual polices of health insurance are subject to HIPAA’ s individual insurance market rules, which include guaranteed availability, guaranteed renewability and certificate of creditable coverage requirement
