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P is for Portability

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A current employee . . . [is] eligible for special enrollment . . . if— (A) The employee . . . [is] otherwise eligible to enroll . . . [and] (B) When coverage under the plan was previously offered, the employee had coverage under any group health plan or health insurance coverage . . . .”

45 C.F.R. § 146.117(a)(2)

Common sense conditions apply, but the gist of that is that if you declined health insurance coverage with your current employer because you were already covered under some other health insurance, and then you subsequently lose that other coverage, your employer’s health insurance plan is required to provide you a special enrollment period.

Some rude health insurance company employee wants Kelly to believe that it’s “against state law” for them to allow him to come into his company’s plan now, upon losing coverage under his dad’s company’s health plan. Against state law? Since when did state law trump HIPAA? Not!

Kelly’s situation is one of the simplest illustrations of what the P in HIPAA stands for. A health insurer’s employee should not be acting as a representative for the insurer without knowing that very basic rule.

Bumper Sticker [] - paterfamilias

Written by macheide

27 August 2008 at 6:05 pm

Posted in paterfamilias


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