Benefits of HIPAA (top)
There is no Pre-existing condition clause as you’ve had prior credible coverage which would count towards any waiting periods. Coverage is guaranteed and you can not be cancelled until you reach Medicare Age.
If the Insurance Company tries to deny your claim, or give you a run around, asking about Pre-X, do NOT let them. Double check your Explanation of Benefits (EOB)
We love to help. We enjoy your inquiries via email and scanned documents in .pdf. Otherwise, we are like the Maytag Repairman waiting for problems to solve.
HIPAA is also there for you if you worked for an:
or your employer went or goes out of business and you do not qualify for COBRA or CAL COBRA
Please note that one can only pick a plan ONCE. There is no shopping around at renewal.
§300 GG b 1 b
What forms or proof do I need that I exhausted my COBRA or was not eligible?
The best and simplest explanation we have found is on Blue Shield’s Website and is called:
HIPAA Guaranteed Issue Information Request Form
What does exhausted [ends] mean? top)
If you elect COBRA continuation coverage, options that may have been available to you before electing COBRA coverage may still be available after COBRA coverage is exhausted (ends). Additionally, you and your family may qualify for individual health coverage as “HIPAA-eligible individuals” when COBRA coverage is exhausted. (COBRA coverage is exhausted when it ends for any reason other than either failure of the individual to pay premiums on a timely basis or for cause, such as making a fraudulent claim.)
The main things that you need to apply for coverage is:
Sample request for more documentation (top)
Sample Letter – Does your former employer have to offer Cal COBRA?
My COBRA with you runs out this Sunday 8/17.
Please let me know ASAP if Target offers CAL COBRA aka (also known as) California Continuation Benefits Replacement Act CA Insurance Code §§10128.50 et seq. to former employees in California. If not, please send a letter stating that, so that I can apply for HIPAA coverage, as HIPAA at §300gg 41 (B) (4) & (5) requires that I use my 18 months of Cal COBRA FIRST, if it is offered to me.
I already called the CA Dept of Insurance and they ask questions that I do not know the answers to. Such as if you are self insured, or if you do not have to offer CAL COBRA as Insurance Code §10112.5(b) which reads in relevant part that the CA Insurance Code shall not apply to a policy … that covers hospital, medical, or surgical expenses and that is issued outside of California to an employer whose principle place of business and majority of employees are located outside of California.
Agent Dave Fluker’s HIPAA Web Page (Sometimes his material is more recent than ours)