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Your Rights When Buying Individual Arizona Health Insurance

Know Your Rights When Buying Individual Health Insurance

HIPAA, the Health Insurance Portability and Accountability Act of 1996, limits insurers' power to deny or delay claims; reduces your chances of losing existing coverage; makes it easier and less risky to switch health plans; and prohibits insurance discrimination based on health problems. The following are your rights under HIPAA:

Unless you are considered an "eligible individual" under federal and state law, you may be turned down for an individual insurance policy because of your health status and other factors.

To be an "eligible individual," you must meet all of the following criteria:

1. You must have had 18 months of continuous creditable coverage, with at least the last day having been under a group health policy. (Coverage is considered continuous if it is not interrupted by a break of 63 or more consecutive days).
2. You must have used up any COBRA group continuation coverage for which you were eligible. COBRA, which gets its name from the Consolidated Omnibus Budget Reconciliation Act of 1986, is a federal program that gives many individuals the right to continue coverage under a group plan. This law applies to insured plans and self-funded, employer plans.
3. You must not be eligible for Medicare, Medicaid or a group health policy.
4. You must not have other health insurance.
5. You must apply for health insurance for which you are deemed an "eligible individual" within 63 days of losing your prior coverage.

If you meet the criteria, all insurance companies that sell individual health insurance must offer you a policy. This applies to traditional insurance companies and HMOs. Preexisting condition exclusions or waiting periods cannot be imposed on "eligible individuals."

Your status as an "eligible individual" ends when you enroll in an individual policy. You can become an "eligible individual" again by maintaining 18 months of continuous coverage and rejoining a group health policy.