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THE ROLE OF STATE LAWS IN HIPAA

The states are required to pass insurance laws conforming to the federal provisions of HIPAA. The states have some flexibility, however, in the laws they pass, particularly if their laws are more generous to the individual. Specifically, states may:

provide additional special enrollment opportunities for individuals.

provide special enrollment periods greater than 30 days

shorten the length of pre-existing condition exclusion periods.

prohibit the use of pre-existing condition exclusions beyond those described in the federal law.

allow a person to keep creditable coverage for breaks in service beyond 63 days.

reduce the maximum HMO affiliation periods.

In addition, the states may prescribe different effective dates or define small group plans in a different way than federal law.

Return to Limitations on Pre-Existing Condition Exclusions

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