The American Cancer Society does not offer legal advice. This information is intended to provide general background in this area of the law.

The Health Insurance Portability and Accountability Act of 1996 or HIPAA is a law that protects millions of working Americans and their families who have medical conditions or who might have trouble getting medical insurance because of a medical condition that they had before they tried to buy health insurance (called a pre-existing condition).

How does HIPAA help?

The law includes several parts that may help cancer patients:

• It limits what is considered a pre-existing condition. An employer health plan can exclude a medical condition from coverage only if the person had a gap in coverage longer than 63 days, and also received or was recommended to receive treatment or medical advice in the 6 months before enrolling in the plan.

• It limits the time a new employer plan can exclude the pre-existing condition from being covered. This means that the employer can avoid covering costs of medical care for a pre-existing condition for no more than 12 months after the person is accepted into the plan.

• It gives certain people the right to buy individual health insurance if no group health plan coverage is available, and the person has exhausted COBRA or other continuation coverage. Certain conditions and time limits must be met.

• It does not allow employers or their health insurers to discriminate or act unfairly against employees and their dependents based on their health status or genetic information.

• It guarantees certain people the ability to get or renew individual health insurance coverage.

In 2002, the HIPAA laws were expanded to give patients greater access to their own medical records and more control over how their personally identifiable health information is used. In general, health information may not be shared without written permission of the patient. The law addresses the need of health care providers and health insurance plans to protect the privacy of patient health information, too. Medical records must be kept under lock and key and are available only on a need-to-know basis.

The rest of the information here is about how HIPAA may affect your health insurance. It is important to know that some states have laws that, although similar to HIPAA, may offer more generous protections. While HIPAA requires a minimum standard all over the U.S., you may want to contact your state insurance commissioner's office to learn more about the law where you live. See "Additional resources" to get help finding your state's department of insurance or insurance commission.

What doesn't HIPAA Do?

Even though HIPAA adds protections and makes it easier to switch jobs without fear of losing health coverage for a pre-existing condition, the law has limits. For instance, HIPAA:

• does not require that employers offer health coverage

• does not require employers that offer coverage for employees to also cover their families or dependents

• does not guarantee that you can afford the health coverage that is offered

• does not keep an employer from imposing a pre-existing condition exclusion period if you have been treated for a condition during the past 6 months and have had an interruption in your coverage

• does not replace your state as the main regulator of insurance where you live

Even so, HIPAA may lower your chance of losing the coverage you have already. It usually makes it much easier to switch health plans or change jobs without losing coverage if you have a health problem. And it may help you buy coverage on your own if you lose your employer's plan and have no other coverage available -- but only if you meet certain requirements and take action in time to qualify.

Last Medical Review: 04/14/2009
Last Revised: 04/14/2009