HIPAA Situation 8

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Health Action 2014
January 23-25

Hyatt Regency Washington on Capitol Hill

Highlights from Health Action 2013

HIPAA Situation 8:
Uninsured and Planning to Enroll in an Individual Health Plan

Length of time I have had insurance coverage:	Can the plan refuse to enroll me just because I am sick?	Can the plan charge me more based on my health?	Can the plan refuse to cover my illness for a period of time, just because my condition was preexisting?
I am uninsured and have been uninsured for at least 63 days (a significant gap in coverage).	Yes, but . . .	Yes, but . . .	Yes, but . . .
I am currently uninsured, but I had insurance until recently and am HIPAA-Eligible because I: had at least 18 months of insurance coverage without a gap of 63 days or more (a significant gap in coverage); used up my COBRA options or similar state continuation coverage; was most recently enrolled in an employer-sponsored group plan; and am not eligible for Medicaid, Medicare, or coverage through another employer-sponsored plan.	It depends	Yes, but . . .	It depends
I am currently uninsured but I had insurance until recently; however, I am not HIPAA-Eligible because I: did not have 18 months of coverage; did not exhaust my COBRA options or similar state continuation coverage; was not most recently enrolled in an employer-sponsored group plan; or may be eligible for Medicare, Medicaid, or another employer-sponsored plan	Yes, but . . .	Yes, but . . .	Yes, but . . .

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