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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 policies), so your protections may vary if you leave the District of Columbia. 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 D.C. resident.

How am I protected?
In the District of Columbia, 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 the District of Columbia 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 group 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 are a small employer buying a small group health plan, you cannot be turned down because of the health status, age, or any other 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. However, the insurance carrier can turn you down if your small business does not meet the participation or contribution requirements.

• 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, and 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 will be HIPAA eligible. If so, you can buy an individual health policy from any individual insurer operating in the District of Columbia. You will not face a new pre-existing condition exclusion period. Insurers must offer you a choice of at least two policies, including one with comprehensive benefits.

• If you have HMO coverage through your employer and you leave that job, you can buy a conversion policy. You will not face a new pre-existing condition exclusion period.

• If you’re buying individual health insurance, CareFirst Blue Cross Blue Shield must offer you at least one individual health insurance policy on a guaranteed issue basis. You cannot be turned down for this policy because you are sick.

• If you have low or modest household income, you may be eligible for free health coverage for yourself or members of your family. The District of Columbia’s Medicaid program offers free health coverage for pregnant women, families with children, and elderly and disabled individuals with very low incomes. In addition, some women who are diagnosed with breast or cervical cancer may be eligible for medical care through Medicaid.

• If your children are 19 years old or younger, do not have health insurance and meet other qualifications, you may be able to get coverage for yourself and your children through the DC Healthy Families Program. Healthy Families provides comprehensive coverage to enrollees and lasts for a 12 month period.

• If you are a resident of the District of Columbia and do not have health insurance, you may be eligible for health care coverage through the DC HealthCare Alliance. You must meet certain eligibility requirements to participate in this program.

• If you have lost your health insurance and are receiving benefits from the Trade Adjustment Assistance (TAA) Program, you may be eligible for a federal income tax credit to help pay for new health coverage. This credit is called the Health Coverage Tax Credit (HCTC), and it is equal to 65% of the cost of qualified health coverage, including COBRA and a policy offered through CareFirst Blue Cross Blue Shield.

• If you are a retiree aged 55-65 and receiving benefits from Pension Benefit Guarantee Corporation (PBGC), then you may be eligible for the HCTC.