California Property & Casualty Broker-AgentHealth InsuranceHard
A client is covered by a group health insurance plan. They are considering a change in employment and want to understand how their pre-existing conditions might be handled under a new group plan. Which federal law primarily addresses the portability of health coverage and limits restrictions on pre-existing conditions when moving between group health plans?
- AAmericans with Disabilities Act (ADA)
- BEmployee Retirement Income Security Act (ERISA)
- CHealth Insurance Portability and Accountability Act (HIPAA)
- DConsolidated Omnibus Budget Reconciliation Act (COBRA)
Show answer & explanationAnswer & explanation
Correct answer: C. Health Insurance Portability and Accountability Act (HIPAA)
HIPAA (Health Insurance Portability and Accountability Act) includes provisions that limit the ability of new group health plans to exclude coverage for pre-existing conditions, provided there hasn't been a significant break in coverage, and ensures portability of coverage.
Why the other options are wrong
- A. ADA prohibits discrimination against individuals with disabilities but doesn't directly govern health plan portability or pre-existing conditions.
- B. ERISA regulates employee benefit plans, including health plans, but HIPAA is more specific to pre-existing conditions and portability.
- D. COBRA allows for continuation of *existing* group coverage, but HIPAA deals with moving *to a new* group plan and its treatment of pre-existing conditions.
HIPAA Portability Rules
Provisions within HIPAA that aim to protect health insurance coverage for workers and their families when they change or lose their jobs, specifically limiting pre-existing condition exclusions.
- Limits pre-existing condition exclusion periods.
- Provides credit for prior coverage to reduce exclusion periods.
- Guarantees renewability and availability of health coverage for certain individuals.
Memory trick: HIPAA 'helps' you 'port' your health, even with 'pre-existing' conditions.