| You do not want to wait until you are sick or | | | | "Health Insurance Portability and Accountability Act |
| injured to find out what your health insurance | | | | of 1996" (HIPAA) helps people avoid duplicative |
| policy will not cover. Read the policy carefully. | | | | waiting periods for pre-existing conditions when |
| "Exclusions" (also called "Impairment Riders") are | | | | they switch form one insured employer to |
| certain injuries, conditions, or procedures for which | | | | another. |
| an insurance policy will not pay any benefits. | | | | HIPAA says that employees can switch |
| Possible exclusions include: pre-existing conditions; | | | | employers without losing group health insurance or |
| suicide or other self-caused injury; | | | | having a new waiting period for pre-existing |
| sexually-transmitted disease; vision correction; | | | | conditions. Insurers cannot exclude pre-existing |
| noncommercial airline travel; experimental | | | | conditions with a waiting period longer than 12 |
| treatments (ask how they are defined); and | | | | months. Also, prior continuous coverage (without |
| injuries from war. "Cosmetic Surgery" that is | | | | a gap of more than 62 days) must be credited |
| needed because of an injury or congenital defect | | | | toward this 12 months. For example, if you had |
| is usually covered, but covered elective cosmetic | | | | continuous coverage for 5 months before |
| surgery generally is excluded. | | | | switching employers, then your new health plan |
| One of the most common exclusions is for | | | | cannot impose on you a waiting period for |
| pre-existing conditions. A "Pre-Existing Condition" is | | | | pre-existing conditions longer than 12-5=7 months. |
| a medical condition or injury that was diagnosed | | | | If you had coverage for 12 months before |
| or treated prior to the start of the health | | | | switching employers, then your new health plan |
| insurance policy. A policy with an exclusion for | | | | cannot impose any waiting period on you. If you |
| pre-existing conditions does not pay for expenses | | | | are switching employers, then get a "Certificate |
| related to pre-existing conditions. Generally, this | | | | of Credible Coverage" from your prior health plan |
| exclusion lasts for a limited "Waiting Period" after | | | | to ensure credit for past coverage. |
| you start your policy. | | | | HIPPA also mandates the following. Insurers who |
| Pregnancy is not considered a pre-existing | | | | serve employer groups with 2-50 employees |
| condition. Also, health care costs for newborns | | | | must offer insurance coverage to all such groups. |
| and adopted children covered within 30 days | | | | Insurers must cover inpatient coverage for |
| should not be excluded during a waiting period. | | | | mother and infant for at least 48 hours after a |
| Further, employers in interstate commerce with | | | | normal birth or 96 hours after a cesarean section. |
| 15 or more employees must provide the same | | | | The tax deductibility of health insurance premiums |
| benefits for pregnancy, childbirth, and related | | | | for the self-employed was increased. Long term |
| medical conditions as for any sickness or injury. | | | | care insurance premiums are now tax exempt |
| For plans offered by other size employers, you | | | | like those of regular health insurance. HIPAA also |
| should check whether normal pregnancy and | | | | created a federal pilot program for Medical |
| childbirth are covered -- not just complications. | | | | Savings Accounts that we will discuss later. |
| Waiting periods for pre-existing conditions are | | | | A "Rider" is a separate page attached to a |
| intended to discourage people from only signing up | | | | standard policy that documents: coverage for a |
| for health insurance when they know they will | | | | condition that generally would not be covered by |
| need something expensive in the near future. | | | | a standard policy; or exclusion of a specific |
| Unfortunately, waiting periods can also leave | | | | condition that generally would be covered by a |
| people without coverage for chronic conditions | | | | standard policy. An "Endorsement" is similar to a |
| when they switch employers. To address this, the | | | | rider, but is included in the body of the policy. |