Pre-existing Conditions

[Richie1]

I am trying to understand how the HIPAA laws work. Do they only apply for group coverage or any type of coverage. Like I said before my COBRA is exhausting and they approved me for an individual policy without covering pre-existing conditions. Does the law mean they must offer you some sort of insurance or does it mean they must cover your pre-existing conditions or both? Does a certificate of coverage make any difference?

 

[Crabcake Johnny]

Once you expire COBRA the law says you must have a continuation of coverage option in the individual market that covers your pre-ex conditions.

In some states you go into their risk pool, in others the carriers offer conversion plans.

 

[somarco]

trying to understand how the HIPAA laws work

You could ask an agent, which you have already done but didn't like the answers, or you can start here.

 

[Dave020]

Connecticut Health Insurance, CT Health Insurance Plans, Connecticut Health Insurance Quotes

Connecticut Health Insurance High Risk Pool: Health Reinsurance Association of Connecticut

The Health Reinsurance Association of Connecticut is 1 of 30 high risk insurance pools for people with pre-existing conditions that have been turned down for health insurance due to those conditions. It is a state created non-profit organization and they have put caps on premiums between 150% and 200% of a standard health insurance plan and are underwritten by United Healthcare.
The HRA offers four types of CT health plans.

1. Individual Plans. There are two different individual plans, the PPO and the Special Health Care Plan (SHCP). Both plans have a cap of $1,000,000 in benefits for the patient's lifetime, have a 12 month waiting period on all pre-existing conditions and will cover eligible dependants. SHCP is reserved for low income individuals and families. Proof of income is required to apply for SHCP.

1. Conversion Plan. This plan will cover pre-existing conditions immediately under the condition that you have qualifying health insurance for at least 12 months and your application is received within 120 days (4 months) of the end of your health insurance policy. The options for a conversion plan are a PPO, HMO and SHCP.

1. Portability Plan. The portability plan is similar to the conversion plan and covers pre-existing conditions immediately and once again a PPO, HMO and SHCP option are available. In order to get a portability plan there must have been at least 18 months of prior coverage, all other group insurance coverage has been exhausted (such as COBRA) and you have your application in the office with 120 days (4 months) after the voluntary termination of your health insurance plan or within 150 days of involuntary termination.

1. TAA (Trade Adjustment Act) Plan. TAA plans come in both individual and portability plans. Individuals that can enroll in the Individual PPO plan are those who have not had coverage for 150 days. Pre-existing conditions are not covered for one year. The TAA portability plans include the PPO, HMO and SHCP options and will cover pre-existing conditions immediately. You are required to have had at least three months prior insurance, have your application in 120 (voluntary termination) or 150 (involuntary termination) days and must be eligible to receive the Federal Health Coverage Tax Credit.

 

[Richie1]

OK so I guess my next question would be should I decline the offer I received for an individual policy that does not cover my pre-existing conditions and wait until next month when my COBRA ends to convert over to a conversion or portability policy or am I stuck with this new policy now? I have another week to cancel the individual policy but it is with the same company that I have COBRA with now. If I can wait until COBRA ends where according to HIPAA they must cover my pre-existing conditions in a new type of policy I would rather go that route instead of accepting this one. I appreciate all the advice.

 

[Crabcake Johnny]

Richie1 - can you please contact Jesse McDonald - one of the foremost experts on individual coverage in CT. He's site is Modern Insurance - Health Insurance Agent in Milford, CT - Specializing in Health Savings Accounts (HSAs)

He'll be able to help you.

 

[superfly33]

He's doing the right thing by exhausting his COBRA coverage so let's not give him a hard time.

Like a previous poster said, you can enroll in a HIPPA plan with your pre-existing conditions covered.