phone (816) 322-6350

Why Does Certain Health Insurance Plans Have A Waiting Period?

How the Health Insurance Waiting Period Affects Consumers – A Brief Explanation of HIPAA and Consumers’ Rights

This article provides an overview of HIPAA and the rights of consumers to have health insurance coverage. Since the law went into effect in 1996, Title I ensures that any individual who gets pregnant, becomes divorced, loses a job, moves to a new location or switches job cannot be denied coverage by any provider.

Many consumers worry about what will happen to their existing coverage if something unexpected happens and they end up unemployed through no fault of their own. People with preexisting conditions are always worried about having a new carrier deny them coverage when they finally find a new job.

Some people will attempt to make a living working for themselves but individual policies are generally very expensive. Others have to accept a position with an employer who does not have a group coverage plan. This article will provide a general sense of what the Health Insurance Portability and Accountability Act does for consumers.

The Effects of HIPAA on Group Coverage or Small Business Health Insurance Plans

Under the provision of this act, group insurance providers may not deny coverage to any individual for a preexisting condition. This does not mean that an individual is guaranteed coverage. Some employers impose their own requirements based on whether an employee works full time or just a few hours a week. Sometimes coverage is dependent on whether the employee draws an hourly wage or a salary.

Employees must sometimes wait a minimum number of days before coverage kicks in. Either the employer or the provider may impose the wait.

Some business owners require an employee to be working on the actual day coverage takes effect. There is an exception if the employee is sick on that day. A delay in coverage may occur if the employee is waiting to start work.

In many households, the policy provided by one spouse’s employer will cover every member of the household. If that spouse loses the job, the provider working with the other spouse’s employer must offer special enrollment if the plan covers employees’ dependents. If the family adds a dependent through birth, marriage or adoption, the same special enrollment rule applies.

As long as an individual has had creditable coverage for 12 consecutive months, the group provider cannot impose preexisting condition exclusions on the insured. If an exclusion is applied for someone who has not had coverage for more than 63 days, the insured is still covered for treatments unrelated to the preexisting condition.

All employees who have similar positions with the company must pay the same premium for coverage. If two people share the same job description, the insurer cannot require one to pay more for the same policy.

If you need more information about the health insurance waiting period, please call us at (816) 322 6350 to speak to one of our agents.

Eliminate the burden of handling employee benefits and compliance.