01.27.14

HIPPA, Reducing Insurance Exclusionary Periods

Posted in Career, Family at 10 am

I was looking into information about a Certificate of Credible Coverage which is a “Proof of Insurance” for healthcare.

…some people with a history of prior health coverage will be able to reduce the exclusion period even further using “creditable coverage.”

It turns out that HIPPA isn’t just about patient privacy. Its primary purpose is to allow “portability” of insurance between jobs, as long as there isn’t a break of more than 63 days of coverage. (The waiting period when you start a job doesn’t count against that.)

If I have “credible” coverage and less than 63 days of time between jobs, insurance companies are required to take that into account and reduce the exclusion period.

If I had just come from a long-term job (say 3 years or more) and had insurance during that job, a new insurance company might eliminate the exclusionary period altogether. Because I had a short job over the summer with only a month of actual coverage from Cigna, I will probably have a month knocked off my exclusionary period, bringing it down from 6 months to 5 months.

If I could get an additional certificate from the United Healthcare (insurance provider at my job of 7 years prior to last summer) I could probably get the exclusionary period waived entirely.

Here is the relevant text about HIPPA insurance portability from Labor Dept.:

…a preexisting condition exclusion can be imposed on a condition only if medical advice, diagnosis, care, or treatment was recommended or received during the 6 months prior to your enrollment date in the plan. As an example, you may have had arthritis for many years before you came to your current job. If you did not have medical advice, diagnosis, care, or treatment – recommended or received – in the 6 months before you enrolled in the plan, then the prior condition cannot be subject to a preexisting condition exclusion. If you did receive medical advice, diagnosis, care, or treatment within the past 6 months, then the plan may impose a preexisting condition exclusion for that condition (arthritis). In addition, HIPAA prohibits plans from applying a preexisting condition exclusion to pregnancy, genetic information, and certain children.

If you have a preexisting condition that can be excluded from your plan coverage, then there is a limit to the preexisting condition exclusion period that can be applied. HIPAA limits the preexisting condition exclusion period for most people to 12 months (18 months if you enrole late), although some plans may have a shorter time period or none at all. In addition, some people with a history of prior health coverage will be able to reduce the exclusion period even further using “creditable coverage.” Remember, a preexisting condition exclusion relates only to benefits for your (and your family’s) preexisting conditions. If you enroll, you will receive coverage for the plan’s other benefits during that time.

The portion in bold in that last paragraph is something I had never heard of before, but it could potentially eliminate waiting periods when you change jobs.

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