Many people with disabilities or other health conditions worry that if they change jobs, they will lose their health coverage. To lessen this worry, the U.S. Congress passed the Health Insurance Portability and Accountability Act (HIPAA), which says that if an employer offers health coverage, that health plan cannot deny you coverage because of the status of your health. Among other things, HIPAA also limits the maximum amount of time you may have to wait for a pre-existing condition to be covered. HIPAA allows special enrollment in group health plans and it guarantees your right to purchase individual health coverage if you meet certain criteria. If your employer offers coverage to dependents, these rules extend to them as well. California has laws similar to HIPAA that, for some people, offer even further protections.

Overview

The Health Insurance Portability and Accountability Act (HIPAA) has two parts. It provides protections for you and your dependents if you’re trying to get into an employer-sponsored health plan, and it provides protections if you’re seeking coverage under an individual plan. For some Californians, state law provides similar and sometimes more generous protections. DB101 has a program description of Private Health Coverage for those who need more general information.

Note: HIPAA also contains rules about privacy issues that will not be discussed here as they are not disability-specific.

Sources

The following links provide detailed information on HIPAA & California protections. If you want more general information, please go to the DB101 HIPAA & California Protections Resources page.

The U.S. Department of Labor offers information and links to a variety of resources on HIPAA.

U.S. Code: Title 29, Chapter 18, Subchapter I, Subtitle B, part 7, Subpart A addresses requirements relating to portability, access and reliability of health care.

The California laws governing health coverage protections are found in the Health and Safety Code, Sections 1357-1357.17 and 1357.50-1357.54; and Insurance Code 10700-10718.7.

The Georgetown University Health Policy Institute publishes a Consumer's Guide to Getting and Keeping Health Insurance in California, which helps consumers understand health care protections provided under federal and state law, including HIPAA.

Insurance Markets: Rules Governing California’s Individual Insurance Market is a California Health Care Foundation Issues Brief on group and individual coverage. It includes information on HIPAA and related topics.

The California Patient’s Guide Chapter V: Your Rights to Coverage of Pre-existing Conditions examines California and federal law on pre-existing conditions.