The Health Insurance Portability and Accountability Act of 1996 (HIPAA)

This is a federal (US) law with many clauses that can help cancer patients.

It allows a person who has had health insurance for at least 12 months with no long loss of coverage (usually more than 63 days) to change jobs and be guaranteed other coverage with a new employer (as long as that employer offers group insurance). In this case there may be no waiting period and the pre-existing condition exclusion may be reduced or not applied. Also, the employee and his or her partner cannot be denied coverage because of a pre-existing health problem. (See “Pre-existing condition exclusions” under the section, “Other things to know about health insurance.”)

For dependent children and many young adults up to age 26, there are new protections under the Affordable Care Act that do not allow pre-existing condition exclusion periods. (See the section “The Affordable Care Act” and “Health insurance options for young adults” under the section “Options for the Uninsured“ for more information.)

If a cancer patient is uninsured, and takes a job with an employer offering group insurance, the pre-existing condition exclusion period for the employee and his or her partner cannot be longer than 12 months. Pre-existing condition exclusion periods cannot be applied to dependent children and some young adults under the Affordable Care Act, as noted above.

HIPAA requires insurers to renew coverage for all employers and individuals as long as premiums are paid on time.

It also guarantees that group insurance coverage is available for employers with 2 to 50 employees. But it does not require these small employers to buy and offer the insurance to their employees.

HIPAA also helps protect anyone left out of group health coverage after COBRA has run out. If you are eligible and act within 63 days of losing COBRA coverage, HIPAA guarantees that you can buy some type of coverage and that you will have a choice of at least 2 options. But it’s important to know that no one will notify you that you are eligible or of the 63 day time limit. Contact your state insurance department or commission to find out what is available to you, or call us.

For more information about HIPAA ask for our document, What is HIPAA? or contact your state department or commission of insurance. See the section called “To learn more.”