What is HIPAA and how might it apply to me if I lost my group health coverage? Well, HIPAA is an acronym for Health Insurance Portability and Accountability Act of 1996. As the name implies this law was enacted by Congress in 1996 and says that you may be able to apply for an individual California health insurance policy on a guaranteed issue basis. What does that mean? It means that if you are eligible and apply for that individual California health plan you can’t be turned down due to underwriting issues.

What makes you eligible? You may be eligible if:

• Have had coverage for at least 18 months, most recently in a group health plan, without a break in coverage exceeding 63 days (You must apply for guaranteed issue coverage within 63 days of the date of termination from the group plan.)

• Have lost group coverage but not because of fraud or nonpayment of premiums.

• Are not eligible for COBRA/Cal-COBRA coverage; or if COBRA/Cal-COBRA coverage was offered under Federal or state law, elected and exhausted it.

• Are not eligible for coverage under a group health plan, Medicare or Medicaid; or any other health insurance coverage.

More information on HIPAA eligibility is available at the state’s Department of Managed Care website. We can provide information on HIPAA plans available from California Blue Cross company Anthem, Blue Shield of California, and Health Net that are available to HIPAA-eligible clients. You can rely on Vitality Health Insurance professionals to help you each step of the way in securing the private health insurance plan you are eligible for as well as helping you apply for and assemble your supporting documentation which will include these items:

• A copy of the Certificate of Creditable Coverage or letter from previous employer(s) or insurance carrier reflecting 18 months of continuous coverage.

• A copy of the COBRA Expiration/Termination letter or letter from previous employer(s) or insurance carrier showing COBRA/Cal-COBRA was exhausted or not available.

HIPAA Plan from BSC.AccessPlusHMO

HIPAA Plan from BSC.PPOShieldSpectrum5000

HIPAA Plan from BSC.PPOShieldSprectrum5500

HIPAA Plan from BSC.ShieldSavings4000.8000