If you have been declined for Virginia health insurance or have a pre-existing condition that is considered uninsurable, you may qualify for guaranteed health insurance under the HIPAA conversion rules. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was created to make the transition from group health insurance to individual coverage easier, and to make sure people with pre-existing conditions could be accepted for a plan that would cover the conditions, assuming certain requirements are satisfied.
To qualify for HIPAA conversion, you must satisfy ALL of the following requirements:
- You do not have any other health insurance coverage, or it will be involuntarily terminated soon (such as COBRA expiring)
- You have been insured by creditable coverage for at least 18 consecutive months or more with no lapse in coverage of more than 63 days (12 months if the insurer discontinued all of its individual coverage in the state)
- Your most recent coverage was under a group health plan, a governmental plan, a church plan, or an individual plan
- Your most recent coverage was not terminated due to nonpayment of premiums, fraud, or intentional misrepresentations
- You are not eligible for any coverage under a group health plan, Medicare, or Medicaid
- You have accepted and exhausted any group continuation of coverage (including COBRA) that was offered, or you were not offered group continuation of coverage (including COBRA)
If all of those conditions apply to you, you can qualify for guaranteed coverage. Every company has a different way of calculating the premiums required for HIPAA policies, and some are more favorable than others. Below is a comprehensive list of Virginia health insurance HIPAA options:
Anthem Blue Cross/Blue Shield – all plans and deductible levels are available, and you would be assigned Anthem’s “Level 4” risk classification, which requires their highest premium. You can stay on the same plan as other family members that may qualify for better risk classes (Levels 1, 2, or 3). Anthem covers all areas in Virginia that are west of Route 123 in Northern Virginia.
CareFirst Blue Cross / Blue Shield – BlueChoice HMO HIPAA, BluePreferred PPO HIPAA, BluePreferred HSA PPO HIPAA, and BluePreferred Saver PPO HIPAA plans are available. Families applying for HIPAA policies together are charged a “family” rate. Healthier family members can apply separately to reduce the overall cost. CareFirst covers all areas of Northern Virginia that are east of Route 123. BluePreferred PPO HIPAA and BluePreferred PPO HSA HIPAA are great policies for individuals with expensive prescriptions as there is no benefit maximum. Click here to get a CareFirst HIPAA plan quote, compare benefits, and apply online.
Aetna – all plans and deductible levels are available and a maximum 400% rate adjustment is applied to the standard premium (e.g. a $300 monthly premium for standard rates would be $1,200 per month)
Assurant Health – all plans and deductible levels are available and a maximum 400% rate adjustment is applied to the standard premium (e.g. a $300 monthly premium for standard rates would be $1,200 per month)
Humana – all plans and deductible levels are available, rates determined by Humana, may be up to 400-500% of the standard premium.
United Health One / United Healthcare – all plans and deductible levels are available and a maximum 220% rate adjustment is applied to the standard premium (e.g. a $300 monthly premium for standard rates would be $660 per month)
To get a comprehensive evaluation of your HIPAA guaranteed health insurance eligibility and a specific HIPAA premium quote, please give us a call at 1-800-571-2980. You can also send us an e-mail at Info@terminsurancebrokers.com or click the banners above or below to begin comparing the plans available in your specific zip code.