HIPAA Guaranteed-Issue

• List of insurance companies in Florida providing HIPAA guaranteed-issue policies
  [Division of Consumer Services]

What is HIPAA?

 

HIPAA stands for the 1996 Health Insurance Portability and Accountability Act.  If you meet the requirements to be a “HIPAA-Eligible” individual, all health insurance companies who provide individual/family health insurance plans must offer a policy to you regardless of your health status or medical history. 

 

What are the benefits of becoming HIPAA-Eligible?

 

You are no longer subject to medical underwriting and will be able to get a “guaranteed-issue” policy for the same rate as other individuals, regardless of your health status.

 

This is important in the state of Florida because current law allows insurance companies to turn down individuals who are not HIPAA-Eligible if they do not meet the underwriting criteria.

 

How do I become HIPAA-Eligible?

 

A HIPAA-Eligible individual is defined as someone:

• Who has at least 18 months of prior creditable coverage;
• Whose most recent prior creditable coverage was under a group health plan, government health plan, or church plan;
• Who did not lose most recent health coverage for fraud or nonpayment of rate;
• Who is not eligible for coverage under a group plan, Medicare A or B, or Medicaid and does not have other health coverage, and;
• Who elected and exhausted any COBRA continuation or similar state extension of coverage, which they were offered (you are required to elect and exhaust COBRA coverage to gain HIPAA-Eligible status).

Warning: If you accept a short-term policy or a conversion policy after exhausting COBRA, you will no longer qualify for HIPAA eligibility. 

 

How do I apply for a guaranteed-issue HIPAA policy?

 

When COBRA has been exhausted, you have 63 days to file an application to purchase a guaranteed-issue HIPAA policy.  Obtain a Certificate of Creditable Coverage from your insurance company to file with your application.  This Certificate is a written statement showing the length of time you have been covered and can be used as proof of at least 18 months continuous coverage.

 

Are benefits for pre-existing conditions covered immediately?

 

You will get credit for prior creditable coverage.  Waiting periods for pre-existing conditions will be reduced by the amount of time that you had insurance under prior coverage.