HIPPA - Portability

ritamcguire

Situation: One of our employees is getting a divorce. His spouse is currently covered by our company provided medical plan. His wife had a bout with cancer several years ago, but has now fully recovered. Her concern is that after her 36 months of COBRA expire, she will not be able to get medical insurance due to her history of cancer. She is a real eastate agent and works as an independant contractor. The real estate agency does not provide health insurance for their agents. I explained HIPPA's portability provision and told her as long as she didn't let her insurance lapse, she could transfer her coverage to another carrier and that the carrier could not deny her coverage based on a pre-existing condition, i.e., her cancer. I also told her to check the cost of COBRA versus getting her own insurance at this time.

Did I advise her correctly in regards to HIPPA's portability requirements?

Pearce

I believe most states have insurance available in Risk Pools for people who have used all of the COBRA continuation coverage available to them. The coverage is guaranteed issue and there is no pre-ex since the person has been on COBRA coverage for either 18 or 36 months, but the rates are based on the risk pool. You probably should suggest that she contact the office of her state insurance commissioner to get information about individual coverage and portability.

ritamcguire

Thanks. I really hadn't thought about sending her to a state agency.

irenesmsaclaims

This may be a little late, but remember that under HIPAA, the new coverage must recognize creditable coverage (to reduce the pre-ex) if it's GROUP, but individual coverage does not, and underwriting is very strict in individual. Her condition would probably result in a decline.

ritamcguire

Irene:

Thanks. Good info is never too late.