Is it OK for a health insurance issuer to charge a higher premium to one group health plan that covers people with costly health problems, than it charges another employer for their group health plan which covers fewer people with costly health problems?
Yes. HIPAA does not restrict a health insurance issuer from charging a higher rate to one group health plan (or employer) over another. An issuer may take health factors of the people to be covered into account when setting blended rates for group health plans (or employers). This may result in one health plan (or employer) being charged a higher premium than another for the same coverage through the same insurance issuer.
My group health plan has a "non-confinement provision." It states that if a person is confined to a hospital at the time they would normally become eligible for enrollment, they aren't eligible until they leave the hospital. What if I am in the hospital with a low white cell count due to chemotherapy at the time I become eligible for enrollment? Is this allowed?
No. A group health plan may not restrict a person's eligibility, benefits, or the effective date of coverage based on the person being in a hospital or other health care facility. Also, a health plan may not set a person's premium based on their being in the hospital.
My group health plan says that dependents are eligible for coverage only until age 26. But this age restriction does not apply to disabled dependents, who may keep health coverage past age 26. Are they allowed to favor disabled dependents?
Yes. It is OK for a plan or issuer to treat a person with an adverse health factor more favorably by offering extended coverage.
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