HIPPA which stands for The Health Insurance Portability and Accountability Act of 1996, became effective on July 1, 1997. All employer-sponsored group health plans (including HMO), group health insurance, and self funded health plans are all affected by HIPPA. In this legislation pre-existing conditions exclusions, small employer definition, group size, certificate of prior creditable health coverage and guarantee issues and renewals are mentioned.

Preexisting Condition Exclusions
The pre-existing condition limitation periods can be no more restrictive than 6/12, except for late enrollees. This means conditions diagnosed or treated within the six months prior to enrolling a health plan will not be covered for 12 months. The plus side 'is that the length of the waiting period for a pre-existing is reduced if there was prior health coverage in force. If prior coverage was in force, the waiting period is reduced by the number of months the insured had insurance over the past 12 months. Thus, if the employee had coverage for the last 12 months a waiting period would not exist.

Credit towards the satisfaction of a Pre-existing Condition limitation must be provided for prior creditable coverage as long as there has not been a gap in coverage of more than 63 days. The documentation of "Creditable Coverage" must be provided to the employees and dependents when their coverage under the plan ceases.

HIPPA and a great change for small groups in New York prohibits a pre-existing condition for pregnancy, newborns or adopted children who are covered within 30 days. This means the above situations would be covered immediately regardless of whether or not they had privies insurance.

For all size groups, plans are prohibited from having a pre-existing limitation more restrictive than 6/12, except for late enrollees. Late enrollees can have a pre-existing condition limitation up to 6/18. The limitation is not allowed for pregnancy or for newborns or adopted children enrolled within 30 days.

Employer Group Size
A significant change was the size of an employer group. Employers with an average of a least 2 and no more than 50 employees are now considered a small group and are eligible for group rates. This use to be 3 employees before the change. The carriers are requesting verification of employment with the latest filed N-YS-4. This form must show the eligible employees listed.