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HIPAA Eligibility

If you meet certain criteria, you may be eligible for coverage under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This may give you access to similar health plans at a slightly higher cost, but without medical underwriting or pre-existing condition waiting periods. Someone who is eligible for HIPAA must meet all of the following criteria:

  • Have elected and exhausted health insurance benefits through a COBRA or similar group, state, or federal continuation. This would include the Federal Employee Health Benefits Program (FEHBP), FEHBP Temporary Continuation of Coverage (TCC), or state continuation coverage, if available.
  • Have 18 months of creditable coverage with the most recent coverage under an employer-sponsored plan, governmental plan, church plan, or a health benefit plan offered in conjunction with any of these plans. Certificates of creditable coverage must indicate at least 18 months of aggregate health insurance coverage. For Virginia residents: the most recent health care coverage was through individual coverage, a group health plan, a governmental plan or a church plan.
  • Have no more than a 62-day break in coverage.
  • Be ineligible for Medicare A or B, Medicaid, or any other employer-sponsored plan.
  • Not be covered by any other health insurance plan.
  • Not have had prior coverage terminated because of failure to pay the required premium or because you committed fraud.
If you believe that you and/or any of your dependents meet all the criteria above, please call your BlueCross BlueShield representative at (800) 843-4280 to request a special application for coverage. Please note that these products may have different benefit designs, and may cost more than the underwritten coverage offered.

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