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