With the passage of the Health Insurance Portability
and Accountability Act of 1996 (HIPAA), Congress dramatically changed the way health care
coverage is sold, administered and regulated in this country. Although many provisions
duplicated existing California State laws, HIPAA made some dramatic changes. One of these
is the "Group to Individual" portability. HIPAA plans are guaranteed
issue; acceptance is not based on your medical history like regular insurance policies.
However, this plan is not for everybody.
To qualify for a HIPAA plan, you must:
Anthem Blue Cross offers the PPO Share 1500 and 2500 Plans,
featuring a $1500 and $2500 deductible.
Blue Shield offers their $1000 and
$2000 deductible plans. Because they are guaranteed issue (approval is not based on
your medical history), premiums will be higher then the regular plans.
If you are coming off of a group plan, you can always
apply for the regular Anthem Blue Cross or Blue Shield plans at the regular rates. If the
insurance company turns you down you can then apply for the Guaranteed Issue plan (as long
as you meet the above requirements). However, the application must
be received by the insurance company within 63 days of the end of your prior group health
plan. Please contact us for more details
about the guaranteed HIPAA plans.
If you do not qualify for HIPAA, then you may qualify
for the California Major Risk Medical Insurance Policy (MRMIP).
This plan is administered by Anthem Blue Cross but has several insurance options, such as
Anthem Blue Cross, Blue Shield and Kaiser. There is a $75,000 annual benefit and a
$750,000 lifetime benefit. Currently, there is a 6 months waiting list for this plan
once you are accepted. Please contact us for more information.
The U.S. Department of Labor provides an informative and easy-to-understand HIPAA section at http://www.dol.gov/dol/topic/health-plans/portability.htm.
