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Portability Regarding Florida Health Insurance

Health Insurance Portability and Accountability Act (HIPAA)

Federal provisions referred to as the Health Insurance Portability and Accountability Act, and various Florida laws implementing this act, govern many important health insurance continuation situations. Whenever you have a question concerning your health care coverage circumstances when your coverage is terminated, you lose health care benefits when your employment or COBRA ends, or your coverage changes because of a change in carriers or a change in your job, you may ind yourself in a situation where HIPAA protections apply.

If you have any questions regarding your health insurance, you may call the Consumer Helpline toll-free at 1-877-MY-FL-CFO (1-877-693-5236) to discuss your options under HIPAA and state law.

Portability

One of the most important HIPAA protections involves credit for prior coverage, often referred to as portability. HIPAA requires that time spent under previous coverage reduces any waiting period for a pre-existing condition under a new group plan you join. The law also limits these waiting periods to 12 months for a new employee joining the plan or 18 months if an employee decides to join the plan at a later date. (However, a pregnant woman who changes jobs and joins a new plan with two to 50 employees does not have to fulfill a waiting period before the health plan must pay for health care services associated with the pregnancy.)

Your insurance company will issue a "certificate of previous coverage," which is your proof of prior coverage and is required to be issued to you when your coverage terminates. This certificate will include a statement of how long you and any dependents were insured. It will also explain to your new employer or company the range of benefits and coverage you had under that plan or policy.

You may have had health plan benefits for the most recent 12 months from either a group plan or an individual insurance policy. In either case, your previous coverage will generally reduce any waiting period for a pre-existing condition if you apply for a new group plan within 63 days.

Please note: The waiting period a new employee experiences before they are eligible for benefits is not included in the calculation of the 63 days.

"Guaranteed-Issue" Individual Health Insurance Policies

Normally, people seeking individual medical coverage submit to medical underwriting to determine if they are sufficiently healthy to qualify for coverage. However, under certain circumstances, individuals may qualify for guaranteed-issue health policies by virtue of HIPAA and state law, meaning that the coverage must be issued regardless of the applicant's health status.