If you have had California medical insurance for the last 18 months without a gap of more than 63 days, you have a right to buy a HIPAA individual plan. However, you must first use up Federal COBRA/Cal-COBRA if you qualified for it.
When your California group medical insurance ends, your medical plan may have to offer you an individual plan. This is called a conversion plan because you convert from the group to an individual plan. If you qualify for a conversion plan, you cannot be denied insurance because of your medical history. If you buy a conversion plan, you have to pay the premiums. However, you must first use up Federal COBRA/Cal-COBRA if you qualified for it.
HIPAA and Conversion Plan Benefits and Rates
You can see summaries of the benefits and how much a HIPAA plan or Individual Conversion plan will cost. The California Department of Insurance (www.insurance.ca.gov) also oversees some HIPAA and Individual Conversion plans. You may visit their web site or call for information on these plans at (800) 927-HELP (4357).
Questions and Answers
What is HIPAA?
HIPAA stands for the Medical Insurance Portability and Accountability Act. It allows people to buy individual medical insurance when they lose their group medical insurance, even if they have a pre-existing medical condition. If you qualify, all medical plans that sell individual plans must offer you medical insurance. You cannot be denied insurance because of your medical history.
Who can enroll in a HIPAA plan?
You must have had medical insurance for the last 18 months. Your most recent insurance must have been in an employer-sponsored group medical plan. Then you must use up all your Federal COBRA or Cal-COBRA if you qualify. You must not have other medical insurance, such as a group medical insurance, Medi-Cal, or Medicare. Finally you did not lose your most recent medical insurance because you did not pay the premiums or you tried to deceive the medical insurance company.
How do I apply for a HIPAA plan?
You have 63 days from the date your group medical insurance ends or, if you qualify, your Federal COBRA or Cal-COBRA ends, to apply for HIPAA. When you apply for a HIPAA plan, you should provide a Certificate of Creditable Coverage from your last medical plan. This is a letter that says how long you have been covered and helps to prove that you have had 18 months of coverage.
How do I find a HIPAA plan?
All medical plans that sell individual plans must offer their two most popular individual plans to people who qualify for HIPAA.
Can I apply for a HIPAA plan if I have a conversion plan?
No. If you accept a conversion plan or any other individual plan after you use up your Federal COBRA or Cal-COBRA, you cannot apply for a HIPAA plan.
What are my benefits in a HIPAA plan?
You may not have the same benefits or the same premiums that you had with your group medical plan. You should compare the benefits and premiums in a HIPAA plan with the benefits and premiums of a conversion plan, if you qualify for one.
Who can enroll in a conversion plan?
You can enroll in a conversion plan if your employer is ending your group medical insurance and you were in this group plan for at least 3 continuous months before your medical insurance ended. However, you must first use up Federal COBRA/Cal-COBRA if you qualified for it.
You cannot enroll in a conversion plan if the medical plan cancelled your insurance because you did not pay your premiums or because you were not honest with the medical plan.
How do I sign up for a conversion plan?
Your employer must notify you within 15 days after your group medical plan ends that you qualify for a conversion plan. Your medical plan must receive your application and first premium payment within 63 days after your group medical insurance ends.
What are my benefits in a conversion plan?
You may not have the same benefits or the same premiums that you had with your group medical plan. You should compare the benefits and premiums in a conversion plan with the benefits and premiums in a HIPAA plan, if you qualify for one.
Resources
Consumer Guide to Getting and Keeping Medical Insurance in California
Information on COBRA and HIPAA
U.S. Department of Labor COBRA
Information on Federal COBRA and HIPAA
1-866-444-3272 (Spanish, Chinese)
1-877-889-5627 (TTY)
