HIPAA question

[Dry Socks]

Does HIPAA consider an association policy (like ieee medical insurance) to be a 'group' policy ?

If it does, that would be really great.
Currently we have an individual policy that's very expensive and going up 20% every year. DW has a pre-existing condition so we can't switch to another provider. I don't have access to a group plan through work.

I joined ieee about 6 months ago to be eligible for their insurance policy. They'll take us but I have to be a member of ieee for 2 years first. So, the change to the ieee plan won't happen for at least 18 months.

After switching to the ieee plan, does the HIPAA protect me if ieee changes the plan or we need to switch to another provider for some reason ? I found the following quote on Wikipedia:

Title I also forbids individual health plans from denying coverage or imposing preexisting condition exclusions on individuals who have at least 18 months of creditable group coverage without significant breaks and who are not eligible to be covered under any group, state, or federal health plans at the time they seek individual insurance


If that's true and it applies to the ieee plan, then our medical insurance choices in ~ 3 years would be better than now. How cool is that ! ... if it's true.

Any comments are greatly appreciated!

[JB]

Title I also forbids individual health plans from denying coverage or imposing preexisting condition exclusions on individuals who have at least 18 months of creditable group coverage without significant breaks and who are not eligible to be covered under any group, state, or federal health plans at the time they seek individual insurance


If that's true and it applies to the ieee plan, then our medical insurance choices in ~ 3 years would be better than now. How cool is that ! ... if it's true.

Notice how the above says nothing about price. I left a group plan to get individual insurance in another state. I looked in IEEE but they don't offer group insurance in my state. When I looked the best plans had a pre-existing condition clauses. When I asked about this the insurance company said that they also offered a HIPPA compliant plan that has no such clause -- problem is that it was double the price for the same coverage. The insurance company told me that the pre-existing condition clause is in effect even if you don't know that you have the condition! So if 3 months into coverage you're diagnosed with a large tumor you wouldn't be covered because the tumor was already there before coverage started. I ended up with a different provider.

In my experience the HIPPA bullet points sound great but when you get into the details they don't do much for you. I guess that's only partially true if you have a preexisting condition because HIPPA does require that they offer you a plan -- which the insurance commissioner must approve.

[Dry Socks]

Maybe I'm just confused by the language on Wikipedia. It says the 'plan' has to accept me. I think you're saying it's not the plan, it's the company and they can put you in some other more expensive plan

[Scrooge]

To quote Wikipedia:

not everything in Wikipedia is accurate, comprehensive, or unbiased

but it contains quite a few useful pointers to (sometimes) more comprehensive and reliable data.

[free4now]

and who are not eligible to be covered under any group, state, or federal health plans at the time they seek individual insurance

Maybe that's the part that will get you. If you are HIPAA eligible, then you will probably be eligible for some horrible state risk pool coverage, so I'd think the insurance companies would use that to reject you.

HIPAA seems useful in that it ensures that you can get some form of coverage if you follow the rules. But it does nothing towards affordability of coverage. Most if not all insurance companies have special "HIPAA plans" that are expensive and have low coverage but are probably better than the state risk pool. That's what you'll be offered.

[JB]

I may be wrong... When I was shopping for insurance it seemed like one of the companies was in violation of the HIPAA laws. They insisted that they were not in violation because they offered a HIPAA plan. I tried to follow up with the office of the insurance commissioner but that was taking time and leading nowhere.

Be very careful about making decisions based on your understanding of the HIPAA laws. Maybe you should call a local insurance company and tell them that you're interested in switching from the IEEE group plan to theirs and see what they offer you.

[Martha]

I believe the the IEEE association plan is a group plan.* At least it is advertised as such.* Sometimes associations negotiate rates for members but don't actually offer a group plan.*

HIPAA* requires the guarantee of coverage with no pre-existing condition waiting period or exclusions if you are "HIPAA eligible."* But, states comply with HIPAA in different ways.* And, HIPAA does not say anything about cost.* *In some states, HIPAA rules apply to all private insurance companies that sell coverage in the individual health insurance market. Some states, however, have made alternative arrangements to guarantee these HIPAA protections only from the state high-risk pool. Some of these risk pools offer very little, with low lifetime caps and sometimes even yearly caps. Private insurers in these states are still free to medically underwrite their policies and deny applicants and impose pre-existing condition waiting periods, even for HIPAA eligible individuals.

Some states also limit how much insurers can charge HIPAA eligible individuals (and often other residents) for coverage.* But most states do not.*




To be HIPAA-eligible, you must meet all of the following criteria:

You must have had 18 months of continuous creditable coverage, at least the last day of which was under a group health plan (including those offered by public employers and churches).

You also must have used up any COBRA or state continuation coverage for which you were eligible.

You must not be eligible for Medicare, Medicaid or a group health plan.

You must not have health insurance. (Note, however, if you know your group coverage is about to end, you can apply for coverage for which you will be federally eligible.)

You must apply for health insurance for which you are federally eligible within 63 days of losing your prior coverage.

[Dry Socks]

Thank you for all the replys!

It looks like Martha's comment "states comply with HIPAA in different ways" is the crux of the matter. I'm glad we have a lot of time to figure it out.

I'd make some comment here about fixing the system but that's been done big time in some of the other posts!