Questions & Answers on Louisiana Health Insurance Portability

Questions and Answers About HIPAA

What if I don't receive a certificate of creditable coverage, or lose one that I received?

A certificate of credible coverage indicates the length of time you have been continuously covered under a qualifying previous health plan and allows waiver of any waiting period related to a preexisting condition. In most cases, your first step should be to contact the plan administrator or your prior health plan. Ask for a copy of the certificate of creditable coverage; it should be free of charge. If you do not automatically receive a certificate of creditable coverage or receive one before you need it, you should:

• Contact the plan administrator if you have been in a group plan;
• Contact the health insurance issuer if you have had individual coverage.

Because some people have had creditable coverage through multiple sources, you should always check with all sources to be sure you get the credit you deserve. If you lose your certificate, you can go back and request another one, free of charge. In most cases, even if you do not receive a certificate, you can use other evidence to prove creditable coverage. These include:

• Pay stubs that reflect a premium deduction;
• Explanation of benefit forms;
• A benefit termination notice from Medicare or Medicaid; and
• Verification by a doctor or your former health care benefits provider that you had prior health coverage.

What are the circumstances in which I will have portability?

(Portability is the exemption of the standard preexisting condition under a subsequent health insurance policy following the termination of a policy or plan from a previous health insurance policy or plan.)

• You lose group health plan coverage, you meet the definition of a HIPAA eligible individual and you wish to purchase individual health insurance coverage.
• You have individual health insurance coverage or any other type of creditable coverage, and you enroll in a new group health plan.

What does portability NOT do?

• Portability does not guarantee that if you move from one plan or policy to another the benefits you receive will be the same as those that were available to you under your old plan or policy. Coverage under the new plan could be less (or more) generous, and premiums and cost-sharing arrangements (deductibles and copayments) may differ.
• It does not "guarantee" that an insurance company has to issue you an individual policy. Insurers have the right to reject coverage based upon their underwriting guidelines. However, if a policy is issued, any creditable coverage that you have will be portable to the new individual health plan.

If I had health coverage under my spouse's old job but I lost that coverage and do not have access to group coverage through my new job, can HIPAA help me as an individual?

• If you meet the requirements to be a HIPAA eligible individual, you must get a choice of individual coverage with no preexisting condition exclusion, either through a health insurance issuer or through the Louisiana Health Plan (HIPAA and/or High Risk Pool).
• In order for you to qualify for the HIPAA pool, loss of group coverage must be through no fault of your own, and you must have been previously insured for at least 18 months continuously.