Numerous state and federal
laws make it easier for people with pre-existing conditions
to get or keep health insurance, or to change from one health
plan to another. A federal law, known as the Health Insurance
Portability and Accountability Act (HIPAA) sets national standards
for all health plans. In addition, states can pass different
reforms for the health insurance plans they regulate (fully
insured group health plans and individual health plans), so
your protections may vary if you leave Minnesota. Neither
federal nor state laws protect your access to health insurance
in all circumstances. So please read this guide carefully.
The following information summarizes how federal
and state laws do or do not protect you as a
Minnesota resident.
How am I protected?
In Minnesota, as 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.
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 in Minnesota 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.
When you buy individual health insurance
there are limits on what you can be charged because of your
health status, age, or where you live.
Your health insurance cannot be canceled
because you get sick. All health insurance is guaranteed renewable.
If you leave your job, you may be able
to remain in your old group health plan for a period of time.
This is called COBRA continuation or state 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 coverage under a fully insured
group health plan in Minnesota, you can buy a conversion policy.
There are rules about what conversion policies must cover
and limits on premiums that can be charged. You cannot be
required to face a new preexisting condition exclusion period.
If you lose your group health insurance
and meet other qualifications, you will be federally eligible.
If so, you can buy an individual health plan from the Minnesota
Comprehensive Health Association (MCHA) high risk pool. You
will not face a new preexisting condition exclusion period.
There are limits on what you can be charged for a MCHA plan.
You can also buy insurance from MCHA
if you have a serious health condition or if you have been
turned down by a health insurance company. In this case you
may face a new preexisting condition exclusion period.
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. This is called
guaranteed issue.
If you are a small employer buying a
group health plan, there are limits on what you can be charged
because of health status, age, or other characteristics of
those in your group.
If have low or modest household income,
you may be eligible for free or subsidized health coverage
for yourself or members of your family. The Minnesota Medicaid
program offers free health coverage for pregnant women, families
with children, elderly and disabled individuals with very
low incomes. Also, if you cannot afford health insurance and
you meet other income requirements, you can buy discounted
coverage for yourself and your family from MinnesotaCare.
The General Assistance Medical Care Program and Prescription
Drug Program also offer coverage for certain low-income persons.