Hipaa Gap Coverage
hipaa gap coverage
Injury requires expensive surgery. Can I switch my high-deductible insurance for a no-deductible? Then drop it?
This no doubt qualifies as a pre-existing injury. But the policy language reads,
“Benefits for pre-existing conditions are not payable until coverage has been in force for 12 consecutive months. If you had prior creditable coverage within 63 days immediately before the date you enrolled under this plan, then the pre-existing conditions exclusion
may be reduced or waived.”
I’ve had “creditable” health insurance for a few years, with no lapse in coverage of 63 days or more, and there would be no gap if I made the switch. So, would my surgery be covered IMMEDIATELY by the new insurance under the HIPPA rules? http://insuranceisugly.com/the-hipaa-law-your-rights-to-health-insurance-portability
zeuz, all medical underwriting takes place BEFORE the application is accepted, correct? Premium amounts and conditions cannot change once an app is accepted, correct?
Thanks.
Is it a group policy or an individual policy? The HIPAA rules only apply with group policies. Group policies will only allow you to switch during open enrollment. It will depend upon the insurance company if the pre-existing condition exclusion is waived. The law “allows” companies to reduce or waive the exclusion but it doesn’t dictate that they must.
With an individual plan, any time you switch to a plan with a lower deductible or richer benefits you will be underwritten. You wanting to switch will throw up red flags and the insurance company will do extensive underwriting. A pending surgery will result in a decline of the new coverage.
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