What HIPAA Means for Cancer Patients and Survivors

What is HIPAA: HIPAA stands for The Health Insurance Portability and Accountability Act of 1996.  According to the government, “the HIPAA Privacy Rule provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes.”

What does HIPAA mean for cancer patients: This is important for people who have or have had cancer (or other diseases) because it is a law that protects employed Americans and their families who might have difficulty getting medical insurance due to a pre-existing condition (a condition that they had before they tried to purchase health insurance.) HIPAA also does not allow employers or their health insurers to differentiate or act in a discriminatory manner against employees based on their health or genetic history/information.

In addition, HIPAA restricts what falls under the category of “pre-existing condition.” According to the American Cancer Society (ACS), “an employer health plan can exclude a medical condition from coverage only if the person had a gap in coverage longer than 63 days, and also had or was suggested to have treatment or medical advice in the 6 months before enrolling in the plan.”

The Affordable Care Act (ACA) has changed things a bit recently. The ACA does not allow insurance companies to refuse coverage for pre-existing conditions in children. And, in 2014, it will not allow refusal of coverage of pre-existing conditions in adults.

Also, another aspect of the ACA is that that each state must have a Pre-Existing Condition Insurance Plan (PCIP) for people who have been uninsured for 6+ months and have cancer or another pre-existing condition. Visit: www.healthcare.gov/law/provisions/preexisting/index.html for details on the PCIP in your state.

Thank you to ACS for much of this helpful information, and for more comprehensive information on HIPAA and what it means for those who have had (or currently have) cancer or sarcoma, please visit Cancer.org.

Please note that this is not legal advice or medical advice and people should always consult a lawyer, insurance expert or medical expert for qualified advice.


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