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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 plans they regulate (fully insured group health plans and individual health plans), so your protections may vary if you leave Oklahoma. 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 an Oklahoma resident.

How am i protected?
In Oklahoma, 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 Oklahoma 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. If you join an HMO, no pre-existing condition exclusion period is allowed.

• 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 your fully insured group health insurance is terminated, you will be able to remain covered for 30 days, or possibly longer, depending on your health status. This is due to an Oklahoma extension of coverage law. This law does not apply to health maintenance organizations (HMOs).

• 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 Health Insurance High Risk Pool (High Risk Pool). You will not face a new pre-existing condition exclusion period. There are limits on what you can be charged for a High Risk Pool policy.

• If you have had difficulty obtaining affordable individual health insurance because of your health condition, you may also be eligible for High Risk Pool coverage. In this case you may face a new pre-existing condition exclusion period. There are limits on what you can be charged for a High Risk Pool 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.

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