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Questions and answers from Oxendine

By Insurance and Fire Commissioner John Oxendine

One of the main reasons for passage of the Health Insurance Portability and Accountability Act (HIPAA) was to make it easier for consumers to move from one health insurance plan to another without the worry of having to meet another pre-existing exclusion period (usually 12 months). This is accomplished by giving consumers creditable coverage for the time they have already been covered under a health insurance plan. Creditable coverage reduces or eliminates the amount of pre-existing time you will spend under a new policy. In order to receive credit for prior coverage you cannot have a lapse in coverage of more than 63 days on out-of-state issued or self-funded policies, or 90 days for a Georgia-issued policy. Group, individual, Medicare and Medicaid are all considered creditable coverage.

Q: I was covered under an individual policy for eight months prior to being hired by my new employer. I am now covered under the group insurance policy for my new employer. What will be the length of my pre-existing period?

A: Since you have eight months of creditable coverage, your pre-existing exclusion period will be reduced to four months.

Q: I worked for three different employers over the past four years. There were times in between each health insurance plan for each employer that I had no health insurance but the times without coverage was never more than 30 days. Will this reduce my creditable coverage period?

A: No. Since the times between each plan were less than 63 days it will not change your creditable coverage time.

Q: I am presently covered under an individual policy that has increased in premium by 50 percent over the past two years. I am familiar with the HIPAA laws concerning portability and thought that I could transfer to any individual policy as long as I had the appropriate amount of creditable coverage time. I applied with a company for an individual policy and was turned down. Can the company do that?

A: Portability is only applicable when you are changing from group to group coverage or in some cases when you are transferring from group to individual. It does not apply when you are changing from one individual policy to another.

Please send your insurance or fire safety questions to Insurance and Fire Commissioner John Oxendine, 716 West Tower, 2 Martin Luther King Jr. Drive, Atlanta, GA 30334. Or call 404-656-2070 (toll free at 1-800-656-2298) for assistance with an insurance question, Monday through Friday, 8 a.m. to 7 p.m. TDD services available at 404-656-4031.