HIPAA is the Health Insurance Portability and Accountability Act of 1996.Passed by Congress in August of 1996; it was effective July 1, 1997. HIPAA provides certain Americans guaranteed access to health insurance coverage regardless of existing health conditions.

If all of the following statements apply to you, you are an Eligible Individual under HIPAA and you qualify for guaranteed access. As of the date on which you apply for coverage:

1. You have had prior creditable coverage for a period in the aggregate of 18 or more months and your most recent prior Creditable Coverage was under a group health plan, governmental plan, or church plan (or health insurance coverage offered in connection with any such plan);

2. You are not eligible for coverage under a group health plan, part A or part B of Medicare, or Medicaid (or any successor program) and do not have other health insurance coverage;

3. Your most recent coverage within the coverage period described in paragraph(1), above, was not terminated based on nonpayment of premiums or fraud.

4. You were offered the option of continuation coverage under a COBRA continuation provision or under a similar State program, and you elected such coverage and have exhausted such continuation coverage under such provisionor program.

Creditable Coverage means, with respect to an individual, coverage of the individual under any of the following:

1. A group health plan.

2. Health insurance coverage.

3. Medicare

4. Medicaid

5. Health insurance plans for members of the U.S. Armed Forces and their

dependents.

6. A medical care program of the Indian Health Service or of a tribal

organization.

7. A State health benefits risk pool.

8. Health insurance plans for employees of the U.S. Government and their

dependents.

9. A public health plan (as defined in regulations).

10. A health benefit plan under section 5(e) of the Peace Corps Act (22-2504(e)).

A period of Creditable Coverage shall not be counted if there was more than a 62-day period during all of which the individual was not covered under any Creditable Coverage.

Eligible Individuals are the only people who have guaranteed access to health insurance under HIPAA. HIPAA requires health insurance carriers to allow guaranteed access to certain plans, at the carrier’s election (Federal Fallback), unless a state adopts an Alternate Mechanism. Under HIPAA, Alternative Mechanisms include high risk pools, guaranteed issue requirements for one or more plans and other methods to assure the access requirements of HIPAA are followed.

Some Facts you should know about using HIPAA