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Frequently Asked Questions (FAQs)
HIPAAIf I change jobs am I guaranteed the same benefits that I have under my current plan?Will I be covered immediately under my new employer's plan? Does HIPAA require employers to offer health coverage or require plans to provide specific benefits? What if my new employer does not provide health coverage? What if I cannot afford the premiums for group health coverage? Does HIPAA extend COBRA continuation coverage? QUESTION: If I change jobs am I guaranteed the same benefits that I have under my current plan? ANSWER: No. When a person transfers from one plan to another, the benefits the person receives will be
those provided under the new plan. Coverage under the new plan can be different than the
coverage under the former plan.
QUESTION: Will I be covered immediately under my new employer's plan? ANSWER: Not necessarily. Plans may set a waiting period before individuals become eligible for benefits.
HMOs may have an "affiliation period" during which an individual does not receive benefits and
is not charged premiums. Affiliation periods run concurrently with any waiting period under a
plan and may not last for more than 2 months (3 months for late enrollees) and are only allowed
for HMOs that do not impose pre-existing condition exclusion periods.
QUESTION: Does HIPAA require employers to offer health coverage or require plans to provide specific benefits? ANSWER: No. The provision of health coverage by an employer is voluntary. HIPAA does not require
specific benefits nor does it prohibit a plan from restricting the amount or nature of benefits for
similarly situated individuals.
QUESTION: What if my new employer does not provide health coverage? ANSWER: There is no requirement for any employer to offer health insurance coverage. If your new
employer does not offer health insurance, you may be eligible to continue coverage under this
Plan's COBRA continuation coverage.
QUESTION: What if I cannot afford the premiums for group health coverage? ANSWER: HIPAA does not limit premium rates, but it does prohibit plans and issuers from charging an
individual more than similarly situated individuals in the same plan because of health status. Plans
may offer premium discounts or rebates for participation in wellness programs. In addition, many
states limit insurance premiums and HIPAA does not preempt state laws regulating the cost of
insurance.
QUESTION: Does HIPAA extend COBRA continuation coverage? ANSWER: Generally no. However, HIPAA makes two changes to the length of the COBRA continuation
coverage period.
Qualified beneficiaries who are determined to be disabled under the Social Security Act within the
first 60 days of COBRA continuation coverage will be able to purchase an additional 11 months of
coverage beyond the usual 18-month coverage period. This is a change from the previous law,
which required that a qualified beneficiary be determined to be disabled at the time of the
qualifying event to receive 29 months of COBRA continuation coverage.
This extension of coverage is also available to non-disabled family members who are entitled to
COBRA continuation coverage.
COBRA rules are also modified and clarified to ensure that children who are born or adopted
during the continuation coverage period are treated as "qualified beneficiaries."
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