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Federal law gives you and your family members some valuable - though limited - protections when you need to buy, change, or continue your health insurance. These important laws can affect the health benefits of millions of Americans and their families. Understanding these protections, as well as laws in your State, can help you make a more informed choice if you need to make a change in health coverage. It also can help you better understand the health coverage protections you have under the law. The purpose of this on-line information is to give you an overview of how you may be affected by health insurance coverage changes that may apply to four different types of coverage: 1) Self-funded group health plans (CMS has jurisdiction over self-funded public sector (non federal governmental) plans while the Department of Labor 866-444-3272 has jurisdiction over private sector self-funded group health plans.); 2) Fully insured group health plans; 3) Individual (non-employment based) health insurance policies; and 4) Comparable coverage through State high risk pools, if applicable in your State. Contact your state's insurance department to find out about whether additional protections apply to your coverage if you are in a fully insured group health plan or have individual market (non-employment based) health coverage. Medicare and Medicaid are not issuers of health insurance. They are public health plans through which individuals obtain health coverage. Contact your specific Medicare or Medicaid contractor to discuss your level of benefits. Employment related group health plans that provide benefits through insurance are known as fully insured group health plans. Employment related group health plans that pay for coverage directly, without purchasing health insurance from an issuer, are called self-funded group health plans. Contact your plan administrator to find out if your group coverage is fully insured or self-funded. Non-employment related individual health insurance policies are sold to individual policy holders. If applicable, your State of residence may offer comparable coverage through a State high risk pool. If you have coverage in one of the four categories listed above, you may have some protections in the following Federal laws: - The Health Insurance Portability and Accountability Act of 1996 (HIPAA);
- The Mental Health Parity Act of 1996 (MHPA);
- The Newborns' and Mothers' Health Protection Act of 1996 (NMHPA); and
- The Women's Health and Cancer Rights Act of 1998 (WHCRA).
This on-line information does not cover all the details of these laws. But it does give you and your family information about your rights and protections. As you read this information, it also is important to remember that health insurance coverage is a complex issue. Your coverage and protections will depend on your specific situation. For example, you may have access to different health coverage protections depending on whether you work and get insurance through your workplace also known as employment based coverage, or whether you have individual (non-employment based) coverage. To help you better understand this and other issues, this on-line information includes general information about these four federal laws. For additional information, you may e-mail us at phig@cms.hhs.gov. Note: A non federal government employer that provides self-funded group health plan coverage to its employees (coverage that is not provided through an insurer) may elect to exempt its plan (opt-out) from most requirements of title XXVII of the Public Health Service (PHS) Act. However, a self-funded non federal governmental plan is still responsible for providing certification and disclosure of an individual's creditable coverage under the plan as well as an opt-out notice to enrollees at time of enrollment and on an annual basis thereafter.
Page Last Modified: 06/16/2008 1:43:33 PM
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