The Health Insurance Portability and Accountability Act (HIPAA) provides a range of protection to millions of working Americans who have some sort of health-related condition or characteristic that makes them vulnerable to exclusions, limitations, and discrimination in group health coverage. HIPAA applies mainly to employer-based health coverage. Therefore, if you get your health insurance through your employer, and if you have what is called a "preexisting condition" (see below) or some other health-related characteristic that makes you "undesirable" in the eyes of an insurance company, you should get to know HIPAA so that you can use it to protect yourself and your family.
A preexisting condition is a condition for which you received medical advice, diagnosis, care, or treatment in the six months prior to enrolling in your current health plan. Cancer and high blood pressure are common pre-existing conditions. For example, you may have received treatment for breast cancer in June, and enrolled in a new group health plan in July. Prior to this Act, you faced the possibility that your new health plan would not cover your breast cancer treatment for several years -- or at all -- simply because you received treatment for it previously.
The intent of HIPAA is to turn the tables on health plans and insurance companies by limiting the ways in which they can exclude coverage of such conditions:
In addition to protecting you from exclusions based on preexisting conditions, HIPAA also protects you from discrimination based on health-related characteristics. The Act prohibits health plans and insurers from excluding you from coverage or charging you more for coverage because of your health status.
Finally, HIPAA requires health care providers, including doctors and hospitals, to improve their efforts to keep your medical records and health information confidential.
If you are a woman who must have a mastectomy due to breast cancer or another medical condition, this law places some requirements on how your group health plan, insurance company, or health maintenance organization must treat you. Under the Act, you are entitled to:
The Women's Health Act applies only to plans that already provide medical and surgical benefits with respect to a mastectomy. If your plan does not provide such benefits, then it is not covered by this Act and you are not entitled to the Act's protections.
To learn more about important federal laws affecting your health insurance benefits, visit the U.S. Department of Labor website at www.dol.gov. For more information on health insurance as it relates to the workplace, see Your Rights in the Workplace, by Barbara Kate Repa (Nolo). And if you need a lawyer's help, the Nolo Lawyer's Directory will help you find one in your area.
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