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This one is about: Change of Insurance - Pre-Existing Conditions Clause


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CHANGE OF INSURANCE: PRE-EXISTING CONDITIONS CLAUSE and the HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)

There is a law that went into effect not long ago called Health Insurance Portability and Accountability Act (HIPAA). Per the article I read in the Washington Post it says "One of the most important aspects of HIPAA is it guarantees that employees who change jobs and who have had insurance coverage for at least 12 months will not have to face any restrictions (called "preexisting condition limitations") in what's covered when they sign up for health insurance at a new employer"

To find out more about HIPAA you can use the internet and go to the following URL's (address on the internet):

Dept. of Labor's website --- two URLS about the HIPAA, the Health Insurance Portability and Accountability Act of 1996

Here's the Final Rule in the Federal Register, this is very technical, but answers all the questions about HIPAA and also contains all the new laws:

http://gatekeeper.dol.gov/dol/pwba/public/regs/fedreg/final/97_8275.htm

The URL for Questions and Answers about the The Health Insurance Portability and Accountability Act of 1996. This website is VERY helpful. It is easier to understand and answers common questions about the laws.

http://gatekeeper.dol.gov/dol/pwba/public/pubs/q&aguide.htm#hipaa

The following information is a brief explanation as to why HIPAA became a law...and was taken from the above website.

This law includes important new protections for millions of working Americans and their families who have preexisting medical conditions or might suffer discrimination in health coverage based on a factor that relates to an individual's health. HIPAA includes changes that:

-limit exclusions for preexisting conditions;

-prohibit discrimination against employees and dependents based on their health status;

-guarantee renewability and availability of health coverage to certain employers and individuals; and

-protect many workers who lose health coverage by providing better access to individual health insurance coverage.

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This law states that if you have insurance and change jobs and that if you do so within a certain time-frame (63 days) then they must waive the pre-existing, as long as you had coverage for more than 12 months. You will need to provide the new insurance company with a letter from the previous insurance carrier or a certificate of insurance coverage that shows your effective date and termination date. (Also for Californians, there is a law that protects children with cleft-lip/palate and they are NOT allowed to have it being pre-existing...maybe other states as well, not sure)

It is the new portability law, one of the good ones that Clinton has gotten approved and it is great for all workers. As long as you have coverage now, and have had that coverage for more than 12 months, then you are ok! Double check with your current insurance they may be able to help give you more info. I used to work in the insurance/benefit dept of my old job.

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The waiting period for pre-existing conditions cannot be longer than 12 months from the day you are hired as long as you enroll the day you are hired or whenever you are eligible. If you wait to enroll, the waiting period can be no longer than 18 months. That is law for everyone. If you go to work for a large school district, you will have a large number of people enrolled in the plan. It's those of us who worked for small organizations that have trouble getting insurance for pre-existing conditions. And a lot of them are going the HMO route like my former employer. The bigger the group, the better the benefits. Some ins. policies have no waiting periods. I know my HMO didn't. There might be a waiting period but they will eventually cover your pre-existing condition. You shouldn't have a problem since you want to be employed by a school district with getting coverage though.

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One other helpful URL for the HIPAA is: http://www.ncsl.org/statefed/hr3103.htm


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