What Rights Do I Have as a Health Insurance Consumer?
If you purchased insurance coverage from a licensed insurer you have the benefit of many important protections.
COBRA Continuation Coverage
If you purchase insurance coverage through your employer and your employer has 20 or more employees, you are entitled to continuation coverage by the federal Consolidated Omnibus Budget Reconciliation Act (COBRA). Your state may require continuation coverage to be offered by smaller employers – typically those with less than 20 employees.
Under COBRA, if you leave your current job you have the option to continue your health care coverage for up to 18 months. You are required to pay the full premium yourself, even if your employer paid part of your premium while you were employed, and the employer may charge an additional, limited administrative fee.
You can find out more about COBRA continuation of group health benefits from the Federal Department of Labor Office of Employee Benefits Security Administration site.
To be an “eligible individual,” you must meet all of the following criteria:
HIPAA is the Health Insurance Portability and Accountability Act of 1996. It limits insurers’ power to deny or delay claims, reduces your chances of losing existing coverage, makes it easier and less risky to switch health plans, and prohibits insurance discrimination based on health problems.
Key HIPAA Protections
State Consumer Protections
States provide a variety of important protections through state law. These may include: the appeal of coverage decisions within the insurance company; the appeal of coverage decisions to an impartial external reviewer; prompt payment of claims; access to certain specialists and health care providers; coverage of specific treatments and services; and many more.
Every state has an insurance department that is ready to help you with any question or complaint you may have about your coverage. To find out more, contact your state insurance department.
© 1991 - 2018 National Association of Insurance Commissioners. All rights reserved.