Hippa
- Thread starter J.R.
- Start date
- 3,384
HIPAA privacy rules or HIPAA guaranteed-issue coverage?
- Thread starter
- #3
- 7,790
You can also type in "hipaa.org" and get quite a bit of information including government websites. Also, you can google "hipaa."
- Thread starter
- #7
Perhaps there is something that I missing, but can somebody explain to me the reasoning behind the following.
How does HIPAA help consumers by offering the ability to get coverage for a pre-exisiting condition if they show proof of creditable coverage, exhuasted coverage, etc.?
I think this would only benefit states where individual or group is guaranteed issue because consumers would have some coverage for a condition, but it doesn't seem to help the individual markets w/out GI mandates.
The insurance company is either going to offer a rider, deny the application, rate-up or offer a CSD or it is off to the state risk pool.
Thoughts????
How does HIPAA help consumers by offering the ability to get coverage for a pre-exisiting condition if they show proof of creditable coverage, exhuasted coverage, etc.?
I think this would only benefit states where individual or group is guaranteed issue because consumers would have some coverage for a condition, but it doesn't seem to help the individual markets w/out GI mandates.
The insurance company is either going to offer a rider, deny the application, rate-up or offer a CSD or it is off to the state risk pool.
Thoughts????
HIPAA portability (at the federal level) applies only to groups of 20 or more. However, the states are the ones who regulate carriers and insured plans so each state has their own version of HIPAA compliant legislation.
In most (but not all) states, their small group laws have adapted HIPAA guidelines.
The portability issue at the federal level applies only when transferring from one group of 20+ employees to another group of 20+ employees. However some states extend portability to small groups as well as individual coverage.
Small groups are very much impacted by HIPAA with rate adjustments to cover pre-ex as high as 100% (perhaps higher). In GA the HIPAA adjustment can be upwards of 67%.
A few carriers in GA (2 come to mind) have also incorporated rules about prior creditable coverage in to their pre-ex clauses. Doesn't mean you will be accepted by the carrier, or accepted without a rate up, only that if you are accepted for coverage your 12 month pre-ex will be reduced by each month of creditable coverage you had without a 63 day break in coverage.
States that have guaranteed issue laws for individual coverage are typically priced 2x - 3x higher than comparable benefits in neighboring states where carriers are allowed to fully underwrite coverage.
So which is better? To charge an unreasonably high rate to everyone to cover the sickies, or spread the risk more adequately by giving preferential rates to those who are healthy and rating, ridering or rejecting those that are unhealthy?
If you were to apply for a loan, your credit history will be underwritten to determine if you qualify for a loan and if so, what rate will be attached to that loan. If some states mandated that anyone who applied for a loan were guaranteed that loan, regardless of ability to pay, then where is the incentive to have good credit & pay off your loans? In such a guaranteed loan state everyone could get a loan and would be charged 18% interest.
What a country!
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- #9
That is an excellent point that I have pondered. If you give people the option to look after their health and not abuse the system you would hope that the majority will do so by making intelligent decisions. Unfortunately, people are so used to co-pays and group coverage taking care of them that the transition to consumer driven plans will take a few years to allow consumers to become more responsible and comfortable with their options. On the other hand, insurance companies negotiate with doctors, hospital and that information is kept top secret.
Wouldn't it be nice if health care was treated in the same way as everything else we purchase. I am a strong advocate of thinking that health insurance is a privilege, but more importantly, that it should be viewed as an avenue to protect consumers from "major" illnesses and accidents versus things like wellness and the occassional office visit.
From your lips to their (politicians) ears!!!
