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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 Utah. 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 Utah resident.

How am I protected?
In Utah, 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 Utah 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 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. 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 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 plan coverage, you also may be able to buy a conversion policy. This is an individual policy sold by the insurance company that covered your former group. There are rules about what conversion policies must cover and limits on what you can be charged.

• If you lose your group health insurance and meet other qualifications, you will be able to buy an individual health plan from either the Utah Comprehensive Health Insurance Pool (HIP) or a private insurer. You will not face a new pre-existing condition exclusion period. There are limits on what you can be charged for this coverage.

• If you apply to buy individual health insurance from a private insurer and you are turned down, you can buy health insurance from HIP. In addition, because HIP only covers very sick individuals, if you do not qualify as a high health risk, you will be given a certificate of insurability that will guarantee you the right to buy individual coverage from a private insurer.

• There are limits on what you can be charged for individual coverage.

• 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 Utah Medicaid program offers free health coverage for pregnant women, families with children, elderly and disabled individuals with very low incomes. The Utah Children's Health Insurance Program also offers coverage for children who have no medical insurance. In addition, the Utah Medical Assistance Program (UMAP) offers coverage to non-elderly adults with life-threatening conditions who do not qualify for Medicaid.