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Q: My husband is taking an early retirement from a company that is compliant with HIPA A regulations. He will sign on to COBRA with me as a dependent. Both of us have preexisting conditions. He will become entitled to Medicare before the first 18 months is exhausted, and that will entitle me to another 18 months of COBRA. After a total of 36 months, I will sign up for HIPAA. In your answers to some of the HIPAA related questions you state “HIPAA restricts the way group health plans apply preexisting condition limitations to its plan participants. It does not apply to individual health plans. “ But here is what HIPAA sites state “HIPAA plans are individual health insurance plans that are most of the time exactly like a regular individual health insurance plan from top companies The only difference is that the HIPAA individual health insurance plan is underwritten on a guaranteed issue basis. However certain criteria must be met”. I fulfill all the HIPAA criteria listed, so why do you think that HIPPA compliant plans will not be available for me?

A:  HIPAA usually applies to group health plans.  As long as you have creditable coverage without a lapse of more than 63 days, an employer’s group plan CAN NOT put limitations or waiting periods on pre-existing conditions.  However, if you are applying for an individual health insurance plans, they are underwritten which means they can put limitations or waiting periods on your pre-existing conditions.  They can also charge you more premiums because of the pre-existing conditions.  Not all insurance companies are required to follow HIPAA laws and they can decline you coverage.  You can contact your state's department of insurance at www.naic.org to see what type of HIPAA plans are available in your state.

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