Kaiser Permanente HIPAA Health Insurance Plans

Kaiser Permanente offers individual HIPAA (“HIPAA Health Insurance Portability and Accountability Act of 1996”) coverage. Eligibility is not subject to medical underwriting, so it is an option to consider if you’ve been denied for individual or family health insurance due to pre-existing medical conditions.

Eligibility Requirements for HIPAA Insurance

HIPAA is subject to federal and state law compliance. Due to HIPAA law, not just anyone can apply. To qualify, you must meet all the requirements below:

  • You must have at least 18 months of creditable coverage. The most recent plan must have been a company insurance policy, a government health plan, or a church medical plan. Also, there can be no lapse of coverage of more than 63 days.
  • You must have completed 36 months of COBRA insurance. This can be achieved either by having 36 months of Cal-COBRA or 18 months of Federal COBRA plus 18 months of Cal-COBRA.
  • You must be uninsured and not eligible for health insurance through a company, the government, a church, Medi-Cal, or Medicare.
  • Your last health plan must not have been cancelled due to fraud or non-payment of premium.

Cost for HIPAA Insurance Coverage

HIPAA is one of the most expensive options for medical coverage. The premium for Kaiser Permanente HIPAA insurance plans is significantly higher than for similar Kaiser Permanente individual plans. The cost is more because it contemplates the high cost of healthcare for people with pre-existing health conditions. Another reason is because the two plans that are offered, the $25 Copayment Plan and the $30/1500 Deductible Plan, provide comprehensive benefits.

Kaiser Permanente HIPAA Insurance Plans

If you enroll for HIPAA with Kaiser Permanente, you can choose to enroll on either of the plans below:

  • $25 Copayment Plan. All covered services are discounted right at the onset. This is the more expensive option of the two.
  • $30/1500 Deductible Plan. Doctor visits and prescriptions are covered without a deductible. All other services are subject to a $1500 deductible. This plan is the more affordable option.

HIPAA Enrollment Process

If you have a pre-existing condition but it is not severe, consider applying for a regular Kaiser Permanente individual plan. The application will ask if you are interested in enrolling on HIPAA if you are eligible. If you are denied for the regular plan but are eligible for HIPAA, Kaiser Permanente will begin the application process by mailing you a HIPAA packet. Included will be information about HIPAA, as well as a request for additional information concerning your prior COBRA and group insurance.