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In general, the Health Insurance Portability and Accountability Act (HIPAA) improves portability and continuity of health insurance coverage by requiring employer group health plans and group health insurance issuers to:
The employee must request the SEP within 30 days of the loss of coverage or life event triggering need.
Preexisting condition exclusions
The Affordable Care Act (ACA) has prohibited all preexisting condition exclusions since 2014.
Employer wellness programs
The ACA and HIPPA also prohibit discrimination based on health factors in an employer wellness program that are related to group health plan coverage. For example, programs that encourage employees to stop smoking, exercise, or reach a target cholesterol level must be designed to promote good health and not to collect health information on an employee or family member to shift more of the cost of health insurance to the employee.
Special enrollment period (SEP)
HIPAA allows individuals who previously declined to enroll in an employer’s health plan to enroll outside of the plan’s annual enrollment period (AEP) in certain special circumstances.
For example, if an employee declines employer health coverage because a spouse’s employer already provides coverage for the family, and then the spouse’s coverage is lost, HIPPA requires that the employer’s plan and issuer permit the employee to enroll in available coverage without having to wait for the next AEP. This is called a SEP.
In general, the Health Insurance Portability and Accountability Act (HIPAA) improves portability and continuity of health insurance coverage by requiring employer group health plans and group health insurance issuers to:
The employee must request the SEP within 30 days of the loss of coverage or life event triggering need.
Preexisting condition exclusions
The Affordable Care Act (ACA) has prohibited all preexisting condition exclusions since 2014.
Employer wellness programs
The ACA and HIPPA also prohibit discrimination based on health factors in an employer wellness program that are related to group health plan coverage. For example, programs that encourage employees to stop smoking, exercise, or reach a target cholesterol level must be designed to promote good health and not to collect health information on an employee or family member to shift more of the cost of health insurance to the employee.
Special enrollment period (SEP)
HIPAA allows individuals who previously declined to enroll in an employer’s health plan to enroll outside of the plan’s annual enrollment period (AEP) in certain special circumstances.
For example, if an employee declines employer health coverage because a spouse’s employer already provides coverage for the family, and then the spouse’s coverage is lost, HIPPA requires that the employer’s plan and issuer permit the employee to enroll in available coverage without having to wait for the next AEP. This is called a SEP.