HIPPA
The Health Insurance Portability and Accountability Act (HIPAA) was enacted by the U.S. Congress in 1996. HIPAA provides rights and protections for participants and beneficiaries in group health plans. It includes protections for coverage under group health plans that limit exclusions for preexisting conditions; prohibit discrimination against employees and dependents based on their health status; and allow a special opportunity to enroll in a new plan to individuals in certain circumstances. It may also give you a right to purchase individual coverage if you have no group health plan coverage available, and have exhausted COBRA or other continuation coverage.

Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs. Title II of HIPAA, known as the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers. It helps people keep their information private.

You can't be turned down for coverage even if you are trying to buy insurance on your own despite your pre-existing condition if you:
● Had at least 18 months of prior coverage from an employer or other group;
● Have used up your COBRA or state continuation coverage rights; and
● Had no gaps in coverage lasting longer than 63 days.

If you meet this criteria, you are considered "HIPAA eligible" and your state must guarantee some health coverage to its HIPAA eligible residents. State governments have responded to HIPAA’s requirements in different ways, and as a result, coverage for individuals in these circumstances usually comes in the form of a High Risk Pool or individual insurance. These options are often open to individuals who are not HIPAA eligible as well, but with different requirements.

HIPPA's anti-discrimination protections guarantee that an individual can't be denied enrollment in a group health plan on the basis of his/her health status, nor can she/he be charged a higher premium due to poor health. In other words, no one can be singled out and charged more or excluded from participating in an employer's group health plan no matter what health condition that individual may have. This goes a long way toward preserving fairness in the system.

Before HIPAA set some limits for exclusions in employee group health policies, many people were effectively locked into their jobs for fear of losing health insurance. HIPAA defines a pre-existing condition as "a condition (whether physical or mental), for which medical advice, diagnosis, care or treatment were recommended or received within the six-month period ending on the enrollment date." Simply stated, it is any health condition for which you saw or consulted a health professional or were treated-which includes taking a prescribed medication-within the six-month period before your new plan started.

A pre-existing condition exclusion is the period of time that a health plan isn't responsible for covering the costs of a pre-existing condition. Very significantly, HIPAA doesn't ban exclusion periods. It limits them to no more than 12 months for first-time enrollment in a health plan, and 18 months for late enrollment (enrollment after or between open enrollment periods).

HIPAA also established a concept called creditable coverage. This gives you (or your covered dependents) credit for the amount of time you were insured by one plan (prior coverage) and applies it to the pre-existing condition exclusion period of a new plan. Prior coverage is not creditable if there is a gap of 63 or more consecutive days without coverage.

HIPAA requires health plans to make this system work. When a covered employee, spouse, or covered dependent leave a plan, they must be given a Certificate of Coverage indicating the amount of time each individual had coverage. If you or a dependent have MS (or any another pre-existing condition) this certificate is the proof of prior coverage that you can apply toward a pre-existing condition exclusion period. Most health plans have these exclusion periods, although some are shorter than the maximum permitted by HIPAA. The law requires all health plans to provide these certificates within a "reasonable" time.