Florida health insurance was impacted in a very positive way about ten years ago. The Health Insurance Portability and Accountability Act of 1996 (HIPAA commonly mistaken for HIPPA) puts limits on pre-existing condition exclusions in group health plans and gives new enrollees credit for prior coverage. In addition to these “portability” requirements, the law also makes it illegal to use health status as a reason for denying coverage, guarantees group coverage for employers with 50 or fewer employees, and guarantees renew ability of group health plans.
Preexisting Condition Waiting Periods Florida Summary
Preexisting condition waiting periods can be offset for one person and 2-50 person groups if the group has 12 months of creditable coverage with no more than a 63 (not 30) day lapse between coverage. For both one person and 2-50 person groups, if the group has less than 12 months of creditable coverage and no more than a 63-day lapse between coverage, they will receive credit for these months of coverage (6/12). At the end of the 12 months there will be no preexisting condition waiting period. If there is no creditable coverage, a one-person group is subject to a 24-month look-back and a 24-month preexisting condition waiting period. A 2-50 person group with no creditable coverage is subject to a 6-month look-back and a 12-month preexisting condition-waiting period.
Maternity and Newborns Florida Summary
Pregnancy will not be considered a preexisting condition and is covered regardless of prior coverage. The only exception is a one-person group with no prior creditable coverage who became pregnant prior to the plan effective date. In this case, the pregnancy will be treated as a preexisting condition and will not be covered.
A one-person group with less than 12 months of creditable coverage can receive credit for the months of coverage. After fulfilling preexisting condition waiting period, the pregnancy must be covered (if applicable).
Newborns who are not enrolled within 30 days of birth may be subject to a preexisting condition waiting period.
Congress recognized the need for national patient record privacy standards in 1996 when they enacted the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The law included provisions designed to save money for health care businesses by encouraging electronic transactions, but it also required new safeguards to protect the security and confidentiality of that information. The law gave Congress until August 21, 1999, to pass comprehensive health privacy legislation. When Congress did not enact such legislation after three years, the law required the Department of Health and Human Services (HHS) to craft such protections by regulation.
There are four parts to HIPAA’s Administrative Simplification:
· Electronic transactions and code sets standards requirements
· Privacy requirements
· Security requirements
· National identifier requirements
Florida health insurance had integrated components affected. HIPAA calls for changes designed to streamline the administration of health care. It promotes uniformity by adopting transaction standards for several types of electronic health information transactions. No longer can every insurer have unique requirements for the processing of claims. Everyone covered by HIPAA will be required to provide the same information — standard formats for processing claims and payments; as well as for the maintenance and transmission of electronic health care information and data.
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