The Health Insurance Portability and Accountability Act of 1996 (HIPAA) includes important - but limited - protections for millions of working Americans and their families. HIPAA may:

1. Increase your ability to get health coverage for yourself and your dependents if you start a new job;
2. Lower your chance of losing existing health care coverage, whether you have that coverage through a job, or through individual health insurance;
3. Help you maintain continuous health coverage for yourself and your dependents when you change jobs; and
4. Help you buy health insurance coverage on your own if you lose coverage under an employer's group health plan and have no other health coverage available.

Among its specific protections, HIPAA

1. Limits the use of pre-existing condition exclusions;
2. Prohibits group health plans from discriminating by denying you coverage or charging you extra for coverage based on your or your family member's past or present poor health;
3. Guarantees certain small employers, and certain individuals who lose job-related coverage, the right to purchase health insurance; and
4. Guarantees, in most cases, that employers or individuals who purchase health insurance can renew the coverage regardless of any health conditions of individuals covered under the insurance policy.

In short, HIPAA may lower your chance of losing existing coverage, ease your ability to switch health plans and/or help you buy coverage on your own if you lose your employer's plan and have no other coverage available.

Misunderstandings About HIPAA

Although HIPAA helps protect you and your family in many ways, you should understand what it does NOT do.

1. HIPAA does NOT require employers to offer or pay for health coverage for employees or family coverage for their spouses and dependents;
2. HIPAA does NOT guarantee health coverage for all workers;
3. HIPAA does NOT control the amount an insurer may charge for coverage;
4. HIPAA does NOT require group health plans to offer specific benefits;
5. HIPAA does NOT permit people to keep the same health coverage they had in their old job when they move to a new job;
6. HIPAA does NOT eliminate all use of pre-existing condition exclusions; and
7. HIPAA does NOT replace the State as the primary regulator of health insurance.

CMS has addressed various HIPAA-related issues in a series of Program Memoranda.  (See downloads.)

If you are unable to find the HIPAA-related information needed on the CMS Website, use the "Submit Feedback" link at the bottom of this page.  A written response will be sent via e-mail.  If a question requires an urgent response, contact our Consumer Helpline at 1-877-267-2323 extension 6-1565.

Note:  For your convenience, the "HIPAA Title I Bulletins" are now individually listed on a separate page, see the left hand side column of this page.  The bulletins can be located by the following categories: Date, Type of Market (i.e., Group, Individual, or Group & Individual), Bulletin Number, and Subject.

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Page Last Modified: 12/03/2007 9:20:26 AM
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