HIPAA and Conversion Coverage
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 up Federal COBRA/Cal-COBRA if you qualified for it.
Conversion Coverage
When your group health insurance 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. 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 up Federal COBRA/Cal-COBRA if you qualified for it.
HIPAA and Conversion Plan Benefits and Rates
You can see summaries of the benefits and how much a HIPAA plan or Individual Conversion plan will cost. The California Department of Insurance (www.insurance.ca.gov) also oversees some HIPAA and Individual Conversion plans. You may visit their web site at or call
Questions and Answers
- What is HIPAA?
- Who can enroll in a HIPAA plan?
- How do I apply for a HIPAA plan?
- How do I find a HIPAA plan?
- Can I apply for a HIPAA plan if I have a conversion plan?
- What are my benefits in a HIPAA plan?
- Who can enroll in a conversion plan?
- How do I sign up for a conversion plan?
- What are my benefits in a conversion plan?
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.
Who can enroll in a HIPAA plan?
- You must have had health insurance for the last 18 months.
- Your most recent insurance must have been in an employer-sponsored group health plan.
- You must first use up all your Federal COBRA/Cal-COBRA if you qualify for it.
- You cannot be eligible to enroll in other group health insurance or be eligible for Medi-Cal or Medicare.
- You cannot have lost your most recent health insurance because you did not pay the premiums or because you committed fraud against 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 HIPAA. 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 helps to prove that you have had at least 18 months of coverage.
If you are unable to provide a Certificate of Creditable Coverage, you may wish to talk to the health plan about other ways you can prove that you had a least 18 months of coverage.
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 qualified for it.
You cannot enroll in a conversion plan if the health plan cancelled your insurance because you did not pay your premiums or because you were not honest with the health plan.
You cannot enroll in a conversion plan if the health plan cancelled 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.
Resources
Consumer Guide to Getting and Keeping Health Insurance in California
Information on COBRA and HIPAA
www.healthinsuranceinfo.net
U.S. Department of Labor COBRA
Information on Federal COBRA and HIPAA
1-866-444-3272 (Spanish, Chinese)
1-877-889-5627 (TTY)
http://www.dol.gov/ebsa