HIPAA Eligible Individual - Health Insurance

What Is a HIPAA Eligible Individual in Health Insurance?

<lingo>Someone who is HIPAA eligible has met the requirements of Title I of HIPAA, the Health Insurance Portability and Accountability Act. Congress passed this act in 1996. HIPAA eligibility means that the individual can retain their health coverage even if they change or lose their jobs. In this case, they cannot lose coverage for any pre-existing medical conditions. There are several HIPAA eligibility requirements that an individual must meet. Most importantly, you must have had at least 18 months of continuous creditable health coverage, but there are other important requirements as well. </lingo>

HIPAA Eligible Individuals Clearly and Briefly Explained

There are actually two parts or titles to the Health Insurance Portability and Accountability Act (HIPAA). When it comes to HIPAA eligible individuals, we’re talking about Title I. Title II deals with medical records and privacy.

For individual plans, Title I of HIPAA guarantees individuals the right to purchase their own health plans and retain previous coverage, especially for pre-existing conditions. Still, to be eligible, you must meet a list of requirements. 

First, you must have had at least 18 months of continuous creditable health coverage prior to needing new coverage. “Creditable health coverage” is essentially considered whatever coverage you had with your previous health care plan. 

<twitter>HIPAA eligibility means that the individual can retain their health coverage even if they change or lose their jobs.</twitter>

Most health care plans count as creditable coverage, including Medicaid and Medicare health plans, individual health plans, and group health plans. In some cases, you’ll need to prove to your new insurance company that you had creditable coverage by obtaining a certificate of creditable coverage from your previous health insurance company.

Here are the other requirements you must meet in order to be considered a HIPAA eligible individual:

• Your final day of previous creditable coverage must have been through a group plan.
• You cannot be eligible for another group plan.
• You cannot be eligible for Medicaid or Medicare.
• You cannot currently have health insurance.
• Application for your new individual health plan must be submitted within 63 days of losing your old job and/or previous coverage.
• You need to have used up the whole of your COBRA coverage.

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