The HIPAA §300 gg- 41 Act (Law) provides you & your family with guaranteed Medical Coverage after your Federal COBRA - which provides 18 months of coverage and then if applicable, Cal - COBRA, which provides an additional 18 months of coverage for a total of THREE years, expires.
There is no Pre-existing condition clause as you've had prior credible coverage which would count towards any waiting periods.
HIPAA rates, brochures and the application.
Do you belong to a new Employer Group of 2 or more employees? Then you might be able to get coverage that way. Click here to enter the group's census.
Click here see what the qualifying questions for HIPAA Guaranteed Coverage are:
Blue Shield
Findlaw.com
Cornell - easiest to read
Federal CMS Site -General Info
Disability 101
If you worked for an Out of State Company with less than 20 employees - then you were NOT offered Cal Cobra, so you are eligible, right away. If you're company was self insured, they don't have to offer Cal Cobra either, so you can get HIPAA at the end of 18 months of Federal COBRA coverage. Just get a letter from you're prior employer or Insurance Company to give to the HIPAA carrier, along with your certificate of credible coverage. Click here for a sample letter to your former employer to find out.
In general, we suggest that you apply for an Insurance Companies or HMO Standard Plan, Rates underwriting and then fill out the HIPAA portion of the application - so that you get the BEST possible rates and coverage.
HIPAA is GUARANTEED Issue, as long as you meet the qualifications (rules) and have your Certificate of Credible Coverage, this way you don't have to worry* about coverage lapsing, while the Insurance Company is checking out your application. Be sure to double check the available start dates of coverage, especially if you want an HMO and your coverage expires in the middle of the month. Friendly competitor Dave Fluker has done an excellent job of research on this. Here's the official response from the DMHC. We've found in practice though that you can get coverage without ANY lapse.
If you don't qualify for HIPAA, you can try MR. MIP
Please email us, we may have other plans and suggestions. It might also be helpful if we email you a short probable underwriting action form, to avoid completing an entire application to see if you qualify, thru the underwriting - application process for a Standard Plan.
Testimonial from a Happy HIPAA Camper
Lapse? Re-Instatement? Grace Period?
In our opinion - once you have HIPAA you SHOULD be able to switch to another HIPAA Insurance Provider - BUT the law §300 GG b 1 b does NOT provide for that. It's at the Insurance Companies option. You might want to write to your Legislative Representatives.
Agent Dave Flukers HIPAA Web Page
Dept. of Managed Health Care Rate & Benefit Survey
If you don't qualify for medical coverage under HIPAA, after your COBRA expires, say you waited too long to apply - you might try Mr. Mip - and of course - any underwritten plan which would save $$$ and may have better coverage and benefits.
Companies may be allowed to use MR MIP and not offer their own plan as allowed by HIPAA law § 300gg–44
"Sample" probable underwriting Pre Existing Condition form.
Disability Benefits 101.org
*If Blue Cross processes this enrollment form, please assign an effective date of _________ .
Requested effective date must be within 63 days of prior coverage termination date. Blue Cross will allow a retroactive effective date to coincide with the prior coverage termination date. Excerpt from Blue Cross HIPAA Application Section 4
I just wrote a policy with Pacifcare, where we submitted the application prior to expiration of the Cal Cobra coverage, but the Certificate of Credible coverage was submitted say a week after and Pacificare honored the original requested effective date of 4/1/2008, so no lapse in coverage.
I just checked with Blue Shield and they said they would do the same thing, but note that the requested date cannot be before the application was received. Also, if there was enough documentation, like phone #'s, etc. they might not even ask for the Certificate of Credible Coverage.
Response from DMHC on effective dates
HIPAA coverage must be obtained within 62 days of the exhaustion of Federal COBRA or Cal-COBRA. The coverage will not be effective back to the date Federal and Cal-COBRA ends. If HIPAA coverage is obtained and paid for before the 15th of the month it is effective the 1st of the following month. If the coverage is obtained and paid for on or after the 15th of the month it is effective the 1st of the second following month. Below are links to more HIPAA information. dol.gov/ dmhc.ca.gov/
Sample Letter - Does your former employer have to offer Cal COBRA?
Dear Target,
My COBRA with you runs out this Sunday 8/17.
Please let me know ASAP if Target offers CAL COBRA aka (also known as) California Continuation Benefits Replacement Act CA Insurance Code §§10128.50 et seq to former employees in California. If not, please send a letter stating that, so that I can apply for HIPAA coverage, as HIPAA at §300gg 41 (B) (4) & (5) requires that I use my 18 months of Cal COBRA FIRST, if it is offered to me.
I already called the CA Dept of Insurance and they ask questions that I do not know the answers to. Such as if you are self insured, or if you do not have to offer CAL COBRA as Insurance Code §10112.5(b) which reads in relevant part that the CA Insurance Code shall not apply to a policy ... that covers hospital, medical, or surgical expenses and that is issued outside of California to an employer whose principle place of business and majority of employees are located outside of California.
Thanks,
