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.
More details on the qualifying questions & eligibility for HIPAA Guaranteed Coverage:
Blue Shield's Questionnaire
§ 300gg–41(b)Cornell Law - easiest to read
Disability 101 FAQ # 16
When your 36 months of
COBRA & CAL COBRA expires
§10128.57
you are guaranteed coverage through HIPAA
until Medicare Kicks in.
HIPAA is also there for you if you worked for an Out of State Employer§10112.5(b)
, or a
Self Insured Plan
,
or your employer went or goes
out of business
and you do not qualify for COBRA or CAL COBRA you should qualify for guaranteed issue coverage under
HIPAA,
and your pre-existing conditions
would be covered
§10128.59
Click here for a sample letter to your former employer to find out.
You might want to shop around
and see if you can get better rates and coverage than
HIPAA. Try our
instant quote engine.
If you are not sure about if you will qualify for a non
guaranteed issue plan, because of
underwriting guidelines try our
pre-underwriting forms. Even if you
don't qualify, the rest of your family might.
There's also
Healthy Families for your kids.
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.
"Sample" probable underwriting Pre Existing Condition form.
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
Consumer Links
Agent Dave Flukers HIPAA Web Page (Sometimes his material is more recent than ours)
Dept. of Managed Health Care Rate & Benefit Survey
"Sample" probable underwriting Pre Existing Condition form.
Disability Benefits 101.org
Federal Center for Medicare & Medicaid Site -General Info
Summaries & Benefits of HIPAA & Conversion Plans from CA Department of Managed Health Care
Misc. FAQ's
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. HMO Help.ca.gov/ You might want to write to your
Legislative Representatives.
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.
Insurance Companies may be allowed to use MR MIP and not offer their own plan as allowed by HIPAA law § 300gg–44
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/
*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.
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,
What does exhausted mean?
If you elect COBRA continuation coverage, options that may
have been available to you before electing COBRA coverage may still be available
after COBRA coverage is exhausted. Additionally, you and your family may
qualify for individual health coverage as "HIPAA-eligible
individuals" when COBRA coverage is exhausted. (COBRA coverage is exhausted
when it ends for any reason other than either failure of the individual to pay
premiums on a timely basis or for cause, such as making a fraudulent claim.)
cms.hhs.gov/
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