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Guide to California HIPAA Medical Insurance

If you have recently exhausted your Cobra, or Cal-Cobra extension of your prior Employer sponsored health insurance plan you may be eligible for what’s called a Guaranteed Issue HIPPA plan.  These plans are designed to give a guaranteed coverage path for individuals who have had at least 18 months of continuous coverage without a 63 day gap.  This can be a crucial option for individuals with health conditions who are not able to purchase a standard individual and family plan due to health conditions or history.  HIPPA plans can get pricey on the premiums so run some quick quotes for individual and family fully underwritten plans here first.


-individuals who have exhausted their Cobra or Cal-Cobra extension rights

-those who have had at least 18 months of continuous employer sponsored coverage without a greater than 63 day gap in coverage

-former enrollees who meet the above criteria who’s group insurance plan was cancelled or company went out of business so there was no Cobra or Cal-Cobra option to continue


To apply for coverage there are several items you can submit to qualify.  Here are some things to ask for:

-a creditable coverage certificate is issued by law when your prior insurance plan terminates.  This is a document which is automatically sent out by your prior insurance carrier which will reflect the names of you and your family members covered, id numbers, & the start and end dates of coverage.

-if you cannot locate your creditable coverage certificate you should not be prevented from applying for your individual HIPPA plan policy.  A letter signed by your former employer, plan administrator, or insurance carrier can suffice as well.

-documentation reflecting your exhaustion of Cobra or Cal-Cobra is necessary if you had a Cobra option.  This typically can be shown by the Cobra exhaustion letter you receive from the Cobra administrator when you are getting ready to make your last Cobra or Cal-Cobra payment.  Or, a signed letter from your former employer or Cobra administrator stating your exhaustion of Cobra will suffice.

-if you had no option to enroll in a Cobra or Cal-Cobra plan then the insurance carrier offering the HIPPA policy will ask you to produce a documentation that your prior company went out of business or terminated offering group insurance to the employees, therefore no Cobra or Cal-Cobra option was available to you.  You can still apply for guaranteed issue HIPPA coverage provided you had minimum 18 months of continuous coverage and apply within 63 days of termination of your group policy.


Unfortunately once you are on a guaranteed issue HIPPA plan the only guaranteed plan change in the individual and family plan category is to stay on your original option.  You can always apply for a fully underwritten individual health plan to see if you qualify.  Or, if your employer situation changes and you become eligible for employer sponsored coverage again you can always enroll in a group insurance plan.  Check out the small group employer plans here if you are self employed or own a company.


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