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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 North Dakota. 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 North Dakota resident.

How am I protected?
In North Dakota, 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 health plans in North Dakota 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 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. 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 your group health insurance and meet other qualifications, you can buy an individual health plan from the Comprehensive Health Association of North Dakota (CHAND) high risk pool or under a group conversion policy. You will not face a new pre-existing condition exclusion period. There are limits on what you can be charged for a CHAND policy.

• You can also buy insurance from CHAND if you have been turned down or excluded for certain coverage by a health insurance company and meet other qualifications. In this case you may face a new pre-existing condition exclusion period.

• If you are able to purchase an individual health plan, there are limits on how much premiums can vary due to age and gender. You can be charged more for your health insurance due to health status, family size and certain other factors. This is called modified community rating.

• 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 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 North Dakota Medicaid program offers free health coverage for pregnant women, families with children, elderly and disabled individuals with very low incomes.

• If your children are 18 years old or younger, do not have health insurance and meet other qualifications, you may be able to buy insurance for them through the Healthy Steps program.