19.6 Health Insurance Portability and Accountability Act of 1996
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) protects an insured person's insurability. Under HIPAA, if a person has been insured consecutively under a group health plan for the past 18 months and does not have access to other health insurance, a new insurance company cannot refuse to cover the person and cannot impose preexisting conditions or a waiting period before providing coverage.
Florida law conforms to HIPAA in the following manners.
Mental Health Parity - It is required that lifetime and annual dollar limitations on mental health benefits (if provided) under group policies be the same as for other medical and surgical benefits under the policy, subject to certain exemptions. Small groups (1-50) are exempt and other groups are exempt if the requirement results in an increase in cost of at least 1%.
Maternity Coverage - An insurer is prohibited from any of the following.
- Denying the mother or her newborn eligibility or continued eligibility to enroll or renew coverage for the purpose of avoiding the requirements of the bill
- Penalizing, reducing or limiting payment to a provider who complies with the bill
- Offering incentives to a provider to render care inconsistent with the law
- Restricting benefits for hospital length of stay which are less favorable than the benefits provided
Guaranteed Renewability - All policies are renewable except for the following reasons.
- Failure to pay premiums
- Fraud or intentional misrepresentation
- The insurer ceases offering coverage, in which case the insurer is prohibited from selling coverage for a specified period of time
Preexisting Conditions - (applies to groups of two or more and HMO group policies only) - Policies may not exclude coverage for preexisting conditions for longer than 12 months (18 months for late enrollees), with a six-month look back. The following also applies.
- Genetic information is not a preexisting condition in the absence of a diagnosis.
- No preexisting condition period may be applied to newborns, adopted children, or pregnancy.
- Credit must be given for time served under other creditable coverage.
Special Enrollment Periods - Employees and their dependents must be allowed to enroll if they previously declined enrollment because they had coverage. New dependents must be allowed to enroll within 30 days of marriage, birth or adoption.
