What is HIPAA?
HIPAA stands for the Health Insurance Portability and Accountability Act. It allows people to buy individual health insurance when they lose their group health insurance, even if they have a pre-existing health condition. If you qualify, all health plans that sell individual plans must offer you health insurance. You cannot be denied insurance because of your medical history.
HIPAA
If you have had health insurance for the last 18 months without a gap of more than 63 days, you may have the right to buy a HIPAA individual plan. However, you must first use Federal COBRA/Cal-COBRA if you qualify.
Conversion Coverage
When your group health insurance (from a job) ends, your health plan may have to offer you an individual plan. This is called a conversion plan because you convert from the group to an individual plan which you buy yourself. If you qualify for a conversion plan, you cannot be denied insurance because of your medical history. If you buy a conversion plan, you have to pay the premiums. However, you must first use Federal COBRA/Cal-COBRA if you qualify.
HIPAA and Conversion Plans through Department of Insurance:
The California Department of Insurance also oversees some HIPAA and Individual Conversion plans. You may visit their web site at www.insurance.ca.gov or call 1-800-927-4357 for information on these plans.
Individual Coverage through Covered California:
As of January 1, 2014, you can buy individual coverage through Covered California. Go to www.coveredca.com. You cannot be denied for a preexisting health condition and depending on your income can get help paying your premiums.
Health Coverage through Medi-Cal:
Medi-Cal is also available for California residents that meet eligibility. You can visit the California Department of Health Care Services’ website at https://www.dhcs.ca.gov/Pages/default.aspx for more information.
Questions and Answers
Who can enroll in a HIPAA plan?
- You must have had health insurance for the last 18 months.
- At least the last day of your credible coverage must have been in an employer-sponsored group health plan.
- You must first use all your COBRA coverage if you qualify.
- You do not have other health insurance, such as a group health insurance.
- You are not eligible for Medi-Cal or Medicare.
- You did not lose your most recent health insurance because you did not pay the premiums or because you tried to deceive the health insurance company.
How do I apply for a HIPAA plan?
You have 63 days from the date your group health insurance ends or, if you qualify, your Federal COBRA or Cal-COBRA ends, to apply for a HIPAA plan. When you apply for a HIPAA plan, you should provide a Certificate of Creditable Coverage from your last health plan. This is a letter that says how long you have been covered and provides proof that you have had at least 18 months of coverage.
If you are unable to provide a Certificate of Creditable Coverage, you can talk to the health plan about other ways you can prove that you had a least 18 months of coverage. Not having a Certificate of Creditable Coverage should not prevent you from obtaining HIPAA coverage with a new health plan.
To avoid a gap in coverage between your last health plan coverage and your HIPAA coverage, you should apply for HIPAA plan before your current health care coverage ends. Health plans must review your application for HIPAA, but will probably not issue you a new policy until your previous plan health coverage ends.
How do I find a HIPAA plan?
All health plans that sell individual plans must offer their two most popular individual plans to people who qualify for HIPAA.
Can I apply for a HIPAA plan if I have a conversion plan?
No. If you accept a conversion plan or any other individual plan after you use up your Federal COBRA or Cal-COBRA, you cannot apply for a HIPAA plan.
What are my benefits in a HIPAA plan?
You may not have the same benefits or the same premiums that you had with your group health plan. You should compare the benefits and premiums in a HIPAA plan with the benefits and premiums of a conversion plan, if you qualify for one.
Who can enroll in a conversion plan?
You can enroll in a conversion plan if your employer is ending your group health insurance and you were in this group plan for at least 3 continuous months before your health insurance ended. However, you must first use up Federal COBRA/Cal-COBRA if you qualify.
You cannot enroll in a conversion plan if the health plan canceled your insurance because you did not pay your premiums or because you committed fraud against the health plan.
How do I sign up for a conversion plan?
Your employer must notify you within 15 days after your group health plan ends that you qualify for a conversion plan. Your health plan must receive your application and first premium payment within 63 days after your group health insurance ends.
What are my benefits in a conversion plan?
You may not have the same benefits or the same premiums that you had with your group health plan. You should compare the benefits and premiums in a conversion plan with the benefits and premiums in a HIPAA plan, if you qualify for one.
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