HIPAA Definition
What is HIPAA

HIPAA stands for the Health Insurance Portability and Accountability Act of 1996. HIPAA enacted reforms in both the group and individual health insurance markets, in part, to help many individuals maintain insurance coverage if they lose or leave their jobs. HIPAA requires all health insurance issuers offering coverage in the individual market to accept any "eligible individuals" who apply for coverage, without imposing a pre-existing condition exclusion . A health insurance issuer means an insurance company, insurance service, or insurance organization (including an HMO) that is licensed to engage in the business of insurance in a state

Am I covered by HIPAA's provisions?
In order to qualify as an "eligible individual" and be covered by HIPAA's provisions, you must meet the following criteria:
  1. You must have at least 18 months of creditable coverage without a significant break in coverage.
  2. Your most recent coverage must have been under an employment-related group health plan, governmental plan or church plan (or health insurance offered in connection with such plans).
  3. You must not be eligible for coverage under a group health plan, Medicare or Medicaid.
  4. You must not have any other health insurance coverage.
  5. Your most recent coverage must not have been canceled for nonpayment of premiums or fraud.
  6. You must have elected and exhausted any option for continuation of coverage (i.e., coverage under the Federal "COBRA" law or a similar State law) that was available under your prior plan.
If you meet the above criteria, you are considered to be an "eligible individual," which means that you must be provided with individual health care coverage without a pre-existing condition exclusion. The premium rates for such coverage are determined by the state law applicable to the health insurance issuer.

Note: Certain children are deemed eligible even if they do not have 18 months of prior creditable coverage. This exception applies to children who were covered under any creditable coverage within 30 days of birth, adoption or placement for adoption, and who did not have a significant break in coverage.
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