Posted by Gelato at 7:05pm Oct 12 '09I seem to remember promising you that I'd look into protections in transferring between health insurance policies. (Though considering it was long enough ago that I can no longer remember which thread that was in, I wouldn't be surprised if you forgot about this too, heh.) I finally found my binder from the Rise To Action '08 Convention (for young adult cancer survivors), and it has a section on Health Insurance and Legal Protections. So, in case you're still interested, here's the info:
What Are Your Rights?
State Laws Offer Some Protection
While there are no guarantees to the right to sufficient healthcare insurance, there are laws that can help survivors keep their coverage.13
- Healthcare coverage under your employer's group health insurance plan cannot be denied or limited because of your cancer history. You also can't be required to pay more than other employees, because of your health status. This is called "nondiscrimination."
[Now, if only the concept of same rates between consumers applied to actual healthcare services, and not just insurance... But, that's another debate for another time, yes?]
- There are limits on pre-existing condition exclusions, which are defined as conditions for which one has received a diagnosis or treatment/medical service (or was recommended to receive) within the six months immediately before joining a plan.
For example, group health plans can deny coverage for a preexisting condition for a maximum of 12 months. There are rules about what counts as a pre-existing condition and how long you must wait before a new health plan will begin to pay for care for that condition.
- Your health insurance cannot be canceled because you get sick. As long as you are covered, most health insurance is guaranteed renewable.
13http://www.healthinsuranceinfo.net
A Federal Law: Health Insurance Portability and Accountability Act (HIPAA)
HIPAA provides some protection in health insurance coverage for employees and their families when they change or lose their jobs. This law also helps protect people from being denied health coverage because of a preexisting condition, such as a cancer history. HIPAA also gives people the right to get copies of their medical records. Other important HIPAA protections include14:
- Limiting how health insurers determine and impose pre-existing condition exclusions such as how long an exclusion period can last
- Not allowing group health plans to discriminate against you by denying you coverage or charging extra because of past or present health problems
- Guaranteeing that people who lose their job-related coverage still have the right to purchase health insurance
- Guaranteeing that employers or people who purchase health insurance can renew their coverage regardless of any health conditions of individuals covered under the insurance policy.
14http://www.cms.hhs.gov/hipaa/hipaa1/content/more.asp [...Which apparently no longer exists.]
So, it looks like the protections apply to group plans, not individual plans. But the wording's a bit more vague on the HIPAA part, so let me take a look at other sources on that...
Aha, found it! Here's an excerpt of the actual law:
`SEC. 701. INCREASED PORTABILITY THROUGH LIMITATION ON PREEXISTING CONDITION EXCLUSIONS.
`(a) LIMITATION ON PREEXISTING CONDITION EXCLUSION PERIOD; CREDITING FOR PERIODS OF PREVIOUS COVERAGE- Subject to subsection (d), a group health plan, and a health insurance issuer offering group health insurance coverage, may, with respect to a participant or beneficiary, impose a preexisting condition exclusion only if--
- `(1) such exclusion relates to a condition (whether physical or mental), regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or received within the 6-month period ending on the enrollment date;
- `(2) such exclusion extends for a period of not more than 12 months (or 18 months in the case of a late enrollee) after the enrollment date; and
- `(3) the period of any such preexisting condition exclusion is reduced by the aggregate of the periods of creditable coverage (if any, as defined in subsection (c)(1)) applicable to the participant or beneficiary as of the enrollment date.
`(b) DEFINITIONS- For purposes of this part--
- `(1) PREEXISTING CONDITION EXCLUSION-
- - `(A) IN GENERAL- The term `preexisting condition exclusion' means, with respect to coverage, a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the date of enrollment for such coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before such date.
- - `(B) TREATMENT OF GENETIC INFORMATION- Genetic information shall not be treated as a condition described in subsection (a)(1) in the absence of a diagnosis of the condition related to such information.
- `(2) ENROLLMENT DATE- The term `enrollment date' means, with respect to an individual covered under a group health plan or health insurance coverage, the date of enrollment of the individual in the plan or coverage or, if earlier, the first day of the waiting period for such enrollment.
- `(3) LATE ENROLLEE- The term `late enrollee' means, with respect to coverage under a group health plan, a participant or beneficiary who enrolls under the plan other than during--
- - `(A) the first period in which the individual is eligible to enroll under the plan, or
- - `(B) a special enrollment period under subsection (f).
- `(4) WAITING PERIOD- The term `waiting period' means, with respect to a group health plan and an individual who is a potential participant or beneficiary in the plan, the period that must pass with respect to the individual before the individual is eligible to be covered for benefits under the terms of the plan.
`(c) RULES RELATING TO CREDITING PREVIOUS COVERAGE-
- `(1) CREDITABLE COVERAGE DEFINED- For purposes of this part, the term `creditable coverage' means, with respect to an individual, coverage of the individual under any of the following:
- - `(A) A group health plan.
- - `(B) Health insurance coverage.
- - `(C) Part A or part B of title XVIII of the Social Security Act .
- - `(D) Title XIX of the Social Security Act , other than coverage consisting solely of benefits under section 1928.
- - `(E) Chapter 55 of title 10, United States Code.
- - `(F) A medical care program of the Indian Health Service or of a tribal organization.
- - `(G) A State health benefits risk pool.
- - `(H) A health plan offered under chapter 89 of title 5, United States Code.
- - `(I) A public health plan (as defined in regulations).
- - `(J) A health benefit plan under section 5(e) of the Peace Corps Act (22 U.S.C. 2504(e)).
Such term does not include coverage consisting solely of coverage of excepted benefits (as defined in section 706(c)).
- `(2) NOT COUNTING PERIODS BEFORE SIGNIFICANT BREAKS IN COVERAGE-
- - `(A) IN GENERAL- A period of creditable coverage shall not be counted, with respect to enrollment of an individual under a group health plan, if, after such period and before the enrollment date, there was a 63-day period during all of which the individual was not covered under any creditable coverage.
- - `(B) WAITING PERIOD NOT TREATED AS A BREAK IN COVERAGE- For purposes of subparagraph (A) and subsection (d)(4), any period that an individual is in a waiting period for any coverage under a group health plan (or for group health insurance coverage) or is in an affiliation period (as defined in subsection (g)(2)) shall not be taken into account in determining the continuous period under subparagraph (A).
- `(3) METHOD OF CREDITING COVERAGE-
- - `(A) STANDARD METHOD- Except as otherwise provided under subparagraph (B), for purposes of applying subsection (a)(3), a group health plan, and a health insurance issuer offering group health insurance coverage, shall count a period of creditable coverage without regard to the specific benefits covered during the period.
- - `(B) ELECTION OF ALTERNATIVE METHOD- A group health plan, or a health insurance issuer offering group health insurance coverage, may elect to apply subsection (a)(3) based on coverage of benefits within each of several classes or categories of benefits specified in regulations rather than as provided under subparagraph (A). Such election shall be made on a uniform basis for all participants and beneficiaries. Under such election a group health plan or issuer shall count a period of creditable coverage with respect to any class or category of benefits if any level of benefits is covered within such class or category.
- - `(C) PLAN NOTICE- In the case of an election with respect to a group health plan under subparagraph (B) (whether or not health insurance coverage is provided in connection with such plan), the plan shall--
- - - `(i) prominently state in any disclosure statements concerning the plan, and state to each enrollee at the time of enrollment under the plan, that the plan has made such election, and
- - - `(ii) include in such statements a description of the effect of this election.
- `(4) ESTABLISHMENT OF PERIOD- Periods of creditable coverage with respect to an individual shall be established through presentation of certifications described in subsection (e) or in such other manner as may be specified in regulations.
`(d) EXCEPTIONS-
- `(1) EXCLUSION NOT APPLICABLE TO CERTAIN NEWBORNS- Subject to paragraph (4), a group health plan, and a health insurance issuer offering group health insurance coverage, may not impose any preexisting condition exclusion in the case of an individual who, as of the last day of the 30-day period beginning with the date of birth, is covered under creditable coverage.
- `(2) EXCLUSION NOT APPLICABLE TO CERTAIN ADOPTED CHILDREN- Subject to paragraph (4), a group health plan, and a health insurance issuer offering group health insurance coverage, may not impose any preexisting condition exclusion in the case of a child who is adopted or placed for adoption before attaining 18 years of age and who, as of the last day of the 30-day period beginning on the date of the adoption or placement for adoption, is covered under creditable coverage. The previous sentence shall not apply to coverage before the date of such adoption or placement for adoption.
- `(3) EXCLUSION NOT APPLICABLE TO PREGNANCY- A group health plan, and health insurance issuer offering group health insurance coverage, may not impose any preexisting condition exclusion relating to pregnancy as a preexisting condition.
- `(4) LOSS IF BREAK IN COVERAGE- Paragraphs (1) and (2) shall no longer apply to an individual after the end of the first 63-day period during all of which the individual was not covered under any creditable coverage.
If you would like to read the rest of Section 701 (there's more), I've included the link below. Also, if you would like to look at the law in its entirety, you can find it here: http://thomas.loc.gov/cgi-bin/query/D?c104:4:./temp/~mdbsZxXiBt::
Hope that helps!
State Laws Offer Some Protection
While there are no guarantees to the right to sufficient healthcare insurance, there are laws that can help survivors keep their coverage.13
- Healthcare coverage under your employer's group health insurance plan cannot be denied or limited because of your cancer history. You also can't be required to pay more than other employees, because of your health status. This is called "nondiscrimination."
[Now, if only the concept of same rates between consumers applied to actual healthcare services, and not just insurance... But, that's another debate for another time, yes?]
- There are limits on pre-existing condition exclusions, which are defined as conditions for which one has received a diagnosis or treatment/medical service (or was recommended to receive) within the six months immediately before joining a plan.
For example, group health plans can deny coverage for a preexisting condition for a maximum of 12 months. There are rules about what counts as a pre-existing condition and how long you must wait before a new health plan will begin to pay for care for that condition.
- Your health insurance cannot be canceled because you get sick. As long as you are covered, most health insurance is guaranteed renewable.
13http://www.healthinsuranceinfo.net
A Federal Law: Health Insurance Portability and Accountability Act (HIPAA)
HIPAA provides some protection in health insurance coverage for employees and their families when they change or lose their jobs. This law also helps protect people from being denied health coverage because of a preexisting condition, such as a cancer history. HIPAA also gives people the right to get copies of their medical records. Other important HIPAA protections include14:
- Limiting how health insurers determine and impose pre-existing condition exclusions such as how long an exclusion period can last
- Not allowing group health plans to discriminate against you by denying you coverage or charging extra because of past or present health problems
- Guaranteeing that people who lose their job-related coverage still have the right to purchase health insurance
- Guaranteeing that employers or people who purchase health insurance can renew their coverage regardless of any health conditions of individuals covered under the insurance policy.
14http://www.cms.hhs.gov/hipaa/hipaa1/content/more.asp [...Which apparently no longer exists.]
So, it looks like the protections apply to group plans, not individual plans. But the wording's a bit more vague on the HIPAA part, so let me take a look at other sources on that...
Aha, found it! Here's an excerpt of the actual law:
`SEC. 701. INCREASED PORTABILITY THROUGH LIMITATION ON PREEXISTING CONDITION EXCLUSIONS.
`(a) LIMITATION ON PREEXISTING CONDITION EXCLUSION PERIOD; CREDITING FOR PERIODS OF PREVIOUS COVERAGE- Subject to subsection (d), a group health plan, and a health insurance issuer offering group health insurance coverage, may, with respect to a participant or beneficiary, impose a preexisting condition exclusion only if--
- `(1) such exclusion relates to a condition (whether physical or mental), regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or received within the 6-month period ending on the enrollment date;
- `(2) such exclusion extends for a period of not more than 12 months (or 18 months in the case of a late enrollee) after the enrollment date; and
- `(3) the period of any such preexisting condition exclusion is reduced by the aggregate of the periods of creditable coverage (if any, as defined in subsection (c)(1)) applicable to the participant or beneficiary as of the enrollment date.
`(b) DEFINITIONS- For purposes of this part--
- `(1) PREEXISTING CONDITION EXCLUSION-
- - `(A) IN GENERAL- The term `preexisting condition exclusion' means, with respect to coverage, a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the date of enrollment for such coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before such date.
- - `(B) TREATMENT OF GENETIC INFORMATION- Genetic information shall not be treated as a condition described in subsection (a)(1) in the absence of a diagnosis of the condition related to such information.
- `(2) ENROLLMENT DATE- The term `enrollment date' means, with respect to an individual covered under a group health plan or health insurance coverage, the date of enrollment of the individual in the plan or coverage or, if earlier, the first day of the waiting period for such enrollment.
- `(3) LATE ENROLLEE- The term `late enrollee' means, with respect to coverage under a group health plan, a participant or beneficiary who enrolls under the plan other than during--
- - `(A) the first period in which the individual is eligible to enroll under the plan, or
- - `(B) a special enrollment period under subsection (f).
- `(4) WAITING PERIOD- The term `waiting period' means, with respect to a group health plan and an individual who is a potential participant or beneficiary in the plan, the period that must pass with respect to the individual before the individual is eligible to be covered for benefits under the terms of the plan.
`(c) RULES RELATING TO CREDITING PREVIOUS COVERAGE-
- `(1) CREDITABLE COVERAGE DEFINED- For purposes of this part, the term `creditable coverage' means, with respect to an individual, coverage of the individual under any of the following:
- - `(A) A group health plan.
- - `(B) Health insurance coverage.
- - `(C) Part A or part B of title XVIII of the Social Security Act .
- - `(D) Title XIX of the Social Security Act , other than coverage consisting solely of benefits under section 1928.
- - `(E) Chapter 55 of title 10, United States Code.
- - `(F) A medical care program of the Indian Health Service or of a tribal organization.
- - `(G) A State health benefits risk pool.
- - `(H) A health plan offered under chapter 89 of title 5, United States Code.
- - `(I) A public health plan (as defined in regulations).
- - `(J) A health benefit plan under section 5(e) of the Peace Corps Act (22 U.S.C. 2504(e)).
Such term does not include coverage consisting solely of coverage of excepted benefits (as defined in section 706(c)).
- `(2) NOT COUNTING PERIODS BEFORE SIGNIFICANT BREAKS IN COVERAGE-
- - `(A) IN GENERAL- A period of creditable coverage shall not be counted, with respect to enrollment of an individual under a group health plan, if, after such period and before the enrollment date, there was a 63-day period during all of which the individual was not covered under any creditable coverage.
- - `(B) WAITING PERIOD NOT TREATED AS A BREAK IN COVERAGE- For purposes of subparagraph (A) and subsection (d)(4), any period that an individual is in a waiting period for any coverage under a group health plan (or for group health insurance coverage) or is in an affiliation period (as defined in subsection (g)(2)) shall not be taken into account in determining the continuous period under subparagraph (A).
- `(3) METHOD OF CREDITING COVERAGE-
- - `(A) STANDARD METHOD- Except as otherwise provided under subparagraph (B), for purposes of applying subsection (a)(3), a group health plan, and a health insurance issuer offering group health insurance coverage, shall count a period of creditable coverage without regard to the specific benefits covered during the period.
- - `(B) ELECTION OF ALTERNATIVE METHOD- A group health plan, or a health insurance issuer offering group health insurance coverage, may elect to apply subsection (a)(3) based on coverage of benefits within each of several classes or categories of benefits specified in regulations rather than as provided under subparagraph (A). Such election shall be made on a uniform basis for all participants and beneficiaries. Under such election a group health plan or issuer shall count a period of creditable coverage with respect to any class or category of benefits if any level of benefits is covered within such class or category.
- - `(C) PLAN NOTICE- In the case of an election with respect to a group health plan under subparagraph (B) (whether or not health insurance coverage is provided in connection with such plan), the plan shall--
- - - `(i) prominently state in any disclosure statements concerning the plan, and state to each enrollee at the time of enrollment under the plan, that the plan has made such election, and
- - - `(ii) include in such statements a description of the effect of this election.
- `(4) ESTABLISHMENT OF PERIOD- Periods of creditable coverage with respect to an individual shall be established through presentation of certifications described in subsection (e) or in such other manner as may be specified in regulations.
`(d) EXCEPTIONS-
- `(1) EXCLUSION NOT APPLICABLE TO CERTAIN NEWBORNS- Subject to paragraph (4), a group health plan, and a health insurance issuer offering group health insurance coverage, may not impose any preexisting condition exclusion in the case of an individual who, as of the last day of the 30-day period beginning with the date of birth, is covered under creditable coverage.
- `(2) EXCLUSION NOT APPLICABLE TO CERTAIN ADOPTED CHILDREN- Subject to paragraph (4), a group health plan, and a health insurance issuer offering group health insurance coverage, may not impose any preexisting condition exclusion in the case of a child who is adopted or placed for adoption before attaining 18 years of age and who, as of the last day of the 30-day period beginning on the date of the adoption or placement for adoption, is covered under creditable coverage. The previous sentence shall not apply to coverage before the date of such adoption or placement for adoption.
- `(3) EXCLUSION NOT APPLICABLE TO PREGNANCY- A group health plan, and health insurance issuer offering group health insurance coverage, may not impose any preexisting condition exclusion relating to pregnancy as a preexisting condition.
- `(4) LOSS IF BREAK IN COVERAGE- Paragraphs (1) and (2) shall no longer apply to an individual after the end of the first 63-day period during all of which the individual was not covered under any creditable coverage.
If you would like to read the rest of Section 701 (there's more), I've included the link below. Also, if you would like to look at the law in its entirety, you can find it here: http://thomas.loc.gov/cgi-bin/query/D?c104:4:./temp/~mdbsZxXiBt::
Hope that helps!
added on 7:10pm Oct 12 '09:
Shit. Apparently the links aren't going to work. If you want to look, go to thomas.loc.gov, and click "Search Multiple Congresses" under Find More Legislation. Type Health Insurance Portability and Accountability Act, click "CHECK ALL" and select "Enrolled Bills Sent to the President." That should give you a manageable list to find the damn thing. (It's from 1996, if that helps.)