HIPAA

HIPAA is the Health Insurance Portability and Accountability Act of 1996. It limits insurers' powers to deny or delay claims, reduces your chances of losing existing coverage, makes it easier and less risky to switch health plans, and prohibits insurance discrimination based on health problems.

Key HIPAA Protections
  • Non-discrimination: In a group plan, the insurer may not apply different eligibility rules, offer different benefits, or charge a higher premium to any individual on the basis of certain “health factors” – health status, claims experience, medical history, or genetic information.
  • Guaranteed issue: Insurers providing small group coverage must offer coverage to any small employer that applies, regardless of health status or prior claims experience of the employees.
  • Guaranteed renewability: Insurers may not cancel a health plan unless the beneficiary fails to pay the premiums or the insurer stops doing business in the market.
  • Limits on pre-existing condition exclusions: Insurers may not exclude (refuse to cover) treatments and services related to medical conditions that existed before the beneficiary purchased the health plan for a period more than 12 months. If the person has had continuous coverage prior to purchasing the new plan, there can be no coverage exclusions.

Contact Information
The South Carolina Department of Insurance is ready to help you with any question or complaint you may have about your coverage. Please do not hesitate to contact the Office of Consumer Services at any time by calling 803-737-6180.