About Health Insurance
How am I protected?
In many other states, your health insurance options are somewhat dependent on your health status. Even if you are sick, however the laws protect you in the following ways.
What are the limits on my protections?
As important as they are, the federal and state health insurance reforms are limited. Therefore, you also should understand how the laws do not protect you.
- Coverage under your group health plan (if your employer offers one) cannot be denied or limited, nor can you be required to pay more, because of your health status. This is called nondiscrimination.
- All group health plans must limit exclusion of pre-existing conditions. There are rules about what counts as a pre-existing condition and how long you must wait before a new group health plan will begin to pay for care for that condition. Generally, if you join a new group health plan, your old coverage will be credited toward the pre-existing condition exclusion period, provided you did not have a long break in coverage.
- Your health insurance cannot be canceled because you get sick. Most health insurance is guaranteed renewable.
- If you leave your job, you may be able to remain in your old group health plan for a certain length of time. This is called COBRA continuation coverage. It can help when you are between jobs or waiting for a new health plan to cover your pre-existing condition. There are limits on what you can be charged for this coverage. If you lose your group health insurance and meet other qualifications, you will be federally eligible.
- If you lose coverage under a fully insured small group health plan, you may be able to buy a conversion policy. You will not face a new preexisting condition exclusion period. There are limits on what you can be charged for a conversion policy.
- If you are a small employer buying a group health plan, you cannot be turned down because of the health status, age, or any factor that might predict the use of health services of those in your group. All health plans for small employers must be sold on a guaranteed issue basis.
- If you are a small employer buying a group health plan, there are limits on what you can be charged due to the health status, age, gender, or occupation of those in your group.
- If you have low or modest household income, you may be eligible for free or subsidized health coverage for yourself or members of your family. The Medicaid program offers free or reduced price health coverage for certain families, children, pregnant women, elderly, and disabled individuals.
Once you obtain coverage, your ability to switch plans may be limited as well. While you have protections when you move from an individual policy to a group plan, federal law does not protect you from the imposition of pre-existing condition exclusions when you move from one individual plan to another, even if you had prior continuous coverage. Furthermore, you are not assured the right to buy another individual policy.
- If you change jobs, you usually cannot take your old health benefits with you. Except when you exercise your federal COBRA rights, you are not entitled to take your actual group health coverage with you when you leave a job. Your new health plan may not cover all of the benefits or the same doctors that your old plan did.
- If you change jobs, your new employer may not offer a health insurance plan. If an employer offers a health insurance plan to its employees, the employer cannot consider factors related to health status in determining whether to offer coverage under the health insurance plan.
- If you get a new job with health benefits, your coverage may not start right away. Employers can require waiting periods before your health benefits begin.
- If you are joining a new group health plan, you may have to satisfy a new pre-existing condition period if you have a break in coverage of 2 months or more.
- Even if you have continuous coverage, there may be a pre-existing condition exclusion period for some benefits if you join a group health plan that covers benefits your old plan did not. For example, say you move from a group plan that does not cover prescription drugs to one that does. You may have to wait up to one year before your new health plan will pay for drugs prescribed to treat a pre-existing condition.
- If you work for a non-federal public employer in Indiana, such as a state or municipal government, not all of the group health plan protections may apply to you.