Health Insurance Ohio Laws - Excel

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Health Insurance Ohio Laws - Excel Powered By Docstoc
					Category Health Insurance & Managed Care
           P
Subcategory rotections in Individual Insurance Markets
Topic      HIPAA Rules
Full Title Non-Group Coverage Rules for HIPAA Eligible Individuals, 2010
Data Type Text

                         Qualifications?                    Are There Minimum Standards for
             State HIPAA ApproachInsurer? Are There Limits on What Can be Charged? What Must be Covered?
                         HIPAA eligible
Alabama Alternative Mechanism High Risk Pool    Yes         Yes
Alaska                   HIPAA eligible         Yes
             Alternative Mechanism High Risk Pool           Yes
Arizona                  HIPAA       All        No          No
             Federal Fallback eligible individual market carriers
                         HIPAA eligible
Arkansas Alternative Mechanism High Risk Pool   Yes         Yes
                         HIPAA       All        Yes         No
California Federal Fallback eligible individual market carriers
                         HIPAA eligible
Colorado Alternative Mechanism High Risk Pool   Yes         Yes
             A           HIPAA eligible
Connecticut lternative Mechanism High Risk Pool Yes         Yes
                         HIPAA       All        No          No
Delaware Federal Fallback eligible individual market carriers
             Federal     HIPAA       All        No          No
District of Columbia Fallback eligible individual market carriers
Florida                  HIPAA eligible         carrier or group prior group Federal Fallback.
                                                            Yes, carrier. No,
             Alternative Mechanism Prior group Yes, prior Federal Fallback carrier. No, Federal Fallback.
Georgia                  HIPAA eligible         carrier or assigned individual market carriers
             Alternative Mechanism Prior group Yes          Yes
Hawaii                   HIPAA       All        No          No
             Federal Fallback eligible individual market carriers
Idaho                    HIPAA eligible         Yes         Yes
             Alternative Mechanism All individual market carriers
Illinois                 HIPAA eligible         Yes
             Alternative Mechanism High Risk Pool           Yes
Indiana                  HIPAA eligible         Yes
             Alternative Mechanism High Risk Pool           Yes
Iowa                     HIPAA eligible         Yes
             Alternative Mechanism High Risk Pool           Yes
Kansas                   HIPAA eligible         Yes
             Alternative Mechanism High Risk Pool           Yes
                         HIPAA eligible
Kentucky Alternative Mechanism High Risk Pool   Yes         Yes
                         HIPAA eligible
Louisiana Alternative Mechanism High Risk Pool  Yes         Yes
Maine                    HIPAA eligible         Yes         Yes
             Alternative Mechanism All individual market carriers
                         HIPAA eligible
Maryland Alternative Mechanism High Risk Pool   Yes         Yes
Massachusetts            HIPAA eligible         Yes         Yes
             Alternative Mechanism All individual market carriers
                         HIPAA eligible         Blue
Michigan Alternative Mechanism Blue Cross Yes ShieldNo
                         HIPAA eligible
Minnesota Alternative Mechanism High Risk Pool  Yes         Yes
                         HIPAA eligible
Mississippi Alternative Mechanism High Risk PoolYes         Yes
                         HIPAA eligible
Missouri Alternative Mechanism High Risk Pool   Yes         Yes
                         HIPAA eligible
Montana Alternative Mechanism High Risk Pool    Yes         Yes
                         HIPAA eligible
Nebraska Alternative Mechanism High Risk Pool   Yes         Yes
Nevada                   HIPAA       All        Yes         Yes
             Federal Fallback eligible individual market carriers
New Hampshire            HIPAA eligible         Yes
             Alternative Mechanism High Risk Pool           Yes
                         HIPAA eligible         Yes         Yes
New JerseyAlternative Mechanism All individual market carriers
New Mexico               HIPAA eligible         Yes
             Alternative Mechanism High Risk Pool or New YesMexico Health Insurance Alliance
                         HIPAA eligible         Yes         Yes
New York Alternative Mechanism All individual market carriers
             Federal Fallback eligible individual market carriers
North Carolina           HIPAA       All        No          No
North Dakota             HIPAA eligible         Yes
             Alternative Mechanism High Risk Pool           Yes
Ohio                     HIPAA eligible         Yes         Yes
             Alternative Mechanism All individual market carriers
                         HIPAA eligible
Oklahoma Alternative Mechanism High Risk Pool   Yes         Yes
Oregon                   HIPAA eligible         Yes         Yes
             Alternative Mechanism All individual market carriers or High Risk Pool
Pennsylvania             HIPAA eligible         Blue
             Alternative Mechanism Blue Cross Yes ShieldNo   plans
Rhode Island             HIPAA       All        No          No
             Federal Fallback eligible individual market carriers
             Alternative Mechanism High Risk Pool
South Carolina           HIPAA eligible         Yes         Yes
South Dakota             HIPAA eligible         Yes
             Alternative Mechanism High Risk Pool           Yes
                         HIPAA       All        No          No
Tennessee Federal Fallback eligible individual market carriers
Texas                    HIPAA eligible         Yes
             Alternative Mechanism High Risk Pool           Yes
United StatesNA          NA          NA         NA          NA
Utah                   HIPAA eligible         Yes
           Alternative Mechanism High Risk Pool            Yes
                       HIPAA eligible         Yes          Yes
Vermont Alternative Mechanism All individual market carriers
Virginia               HIPAA      All         No           No
           Federal Fallback eligible individual market carriers
Washington             HIPAA eligible         Yes           High
           Alternative Mechanism All individual carriers orYes Risk Pool
           Alternative Mechanism High Risk Pool
West Virginia          HIPAA eligible         Yes          Yes
                       HIPAA eligible
Wisconsin Alternative Mechanism High Risk PoolYes          Yes
                       HIPAA eligible
Wyoming Alternative Mechanism High Risk Pool  Yes          Yes


Notes         This chart is applicable to HIPAA eligible individuals. For rules that apply to non-HIPAA eligible individuals, refer to I
Definitions   HIPAA Eligible individuals are guaranteed the right to purchase individual coverage with no pre-existing condition ex
Sources       Data as of January 2010. Data compiled through review of federal and state laws.  For more detailed in
Footnote 1    In Florida, HIPAA eligible individuals leaving fully insured coverage are guaranteed the choice of two standardized c
Footnote 2    In Georgia, HIPAA eligible individual leaving fully insured coverage are guaranteed the choice of at least two "enhan
Footnote 3    In Oregon, HIPAA eligible individuals leaving fully insured coverage are guaranteed a portability plan from individual
Footnote 4    In Washington, HIPAA eligible individuals are guaranteed issue in the individual market under the HIPAA standard,
Footnote 5    In West Virginia, a second approach--Federal fallback--is available. Besides the state High Risk Pool, HIPAA eligibl
or What Must be Covered?




eral Fallback.
n-HIPAA eligible individuals, refer to Individual Market Guaranteed Issue
rage with no pre-existing condition exclusion periods when they leave group coverage.  To be HIPAA Eligible, a person must have had
  ate laws.  For more detailed information on consumer protections in any state see Georgetown University's "Consumer Guides For Ge
 eed the choice of two standardized conversion policies. A second approach--Federal fallback--applies to individuals leaving self-insured plan
 eed the choice of at least two "enhanced conversion" policies from their prior group carrier. HIPAA eligible individuals leaving self-insured gr
 teed a portability plan from individual market insurers. HIPAA eligible residents leaving self-insured group health plans are guaranteed issue
 l market under the HIPAA standard, however individuals that live in counties where individual health insurance policies are not actively mark
e state High Risk Pool, HIPAA eligible individuals are entitled to the guaranteed issue of any carrier's two most popular policies. There are no
 AA Eligible, a person must have had at least eighteen months of prior coverage, not interrupted by a gap of more than sixty-three days in a r
niversity's "Consumer Guides For Getting and Keeping Health Insurance" available at http://www.healthinsuranceinfo.net/.Data collection an
o individuals leaving self-insured plans, who are entitled to the guaranteed issue of any carrier's two most popular policies. There are no ben
ble individuals leaving self-insured group health plans are assigned, by the state of Georgia, to an individual market carrier that must then gu
p health plans are guaranteed issue a portability plan from the state high risk pool. Minimum standards must be covered by all portability pla
urance policies are not actively marketed are guaranteed the right to buy health insurance through the high risk pool.
o most popular policies. There are no benefit standards or rate restrictions on these policies.
p of more than sixty-three days in a row, and the last day of prior coverage must have been in a group health plan.  In addition, upon le
insuranceinfo.net/.Data collection and analysis by researchers at the Health Policy Institute, Georgetown University.
st popular policies. There are no benefit standards or rate restrictions on these policies. However, if the administrator of a self-insured plan o
dual market carrier that must then guarantee issue a choice of two 'HIPAA Assignment" policies. Minimum benefit standards and rate restric
 must be covered by all portability plans. In addition, there are limits on what can be charged for a portability plan.
 gh risk pool.
ealth plan.  In addition, upon leaving group coverage one must elect and exhaust any available COBRA continuation coverage or simi

administrator of a self-insured plan offers a conversion product that is identical to the state's conversion product and that has been filed and
um benefit standards and rate restrictions apply to all HIPAA eligible policies.
bility plan.
OBRA continuation coverage or similar state continuation coverage. A HIPAA eligible individual cannot be eligible for any other group covera

product and that has been filed and approved by the department, an individual's choice under HIPAA is limited to those conversion products
be eligible for any other group coverage or Medicare, and must apply within sixty-three days for HIPAA coverage.HIPAA requires all coverage

limited to those conversion products, instead of the guaranteed issue of any carrier's two most popular plans.
overage.HIPAA requires all coverage sold in the individual market must be available to eligible individuals, unless insurers elect to make only

plans.
ls, unless insurers elect to make only two policies available. Insurers can designate their two most popular individual market policies for fede
lar individual market policies for federally eligible people, or they can designate two "representative" policies that a

				
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