The widely touted Health Insurance Portability and Accountability Act (HIPAA), passed by the Congress in 1996, isn't delivering as promised at least not for everyone.

Generally speaking, HIPAA guarantees you access to new health insurance if you've been in a group plan and lose your job.

Healthy people don't need this law. It's for workers and their families who are dealing with a chronic illness or serious disease. Without HIPAA, insurers might exclude them from coverage.

The new health plan you switch to isn't forced to cover your particular disease, but it can't exclude you while providing that coverage to everyone else.

Most Americans came under HIPAA by last January. Some weren't covered until this month. Starting this month everyone is finally covered. A handful of states already had guaranteed-coverage laws of their own. HIPAA has worked best for job switchers who move from one health plan to another.

"It's now easier to join the new health plan without facing unreasonable exclusions or waiting periods," says Sen. Edward Kennedy, D-Mass., one of the sponsors of the law.

Easy, that is, if you join the new plan within 30 days of becoming eligible. If you don't, and then change your mind, some insurers will require you to wait 18 months for coverage. HIPAA allows this, although some states may not.

Workers with an illness in the family face even higher hurdles when they leave an employee group plan and have to buy an individual policy. This occurs when your new employer has no health plan or if you start working for yourself.

In many states, high-risk individuals including people eligible for HIPAA are diverted into special insurance pools. In others, insurance companies sell HIPAA policies directly.

Some insurers who sell directly haven't been living up to the law. That might have been temporary while insurers learned the rules, says Randy DiRosa, a senior evaluator for the Government Accounting Office in Chicago.

Or it could have been deliberate. Here are the kinds of problems that have been reported:

? Insurers may delay your application, or take a long time to issue a price quote. If 62 days pass from the time you leave your group plan, you no longer qualify for guaranteed coverage under HIPAA. (You still qualify, however, in 13 states that mandate coverage for everyone. Ask your insurance agent about it.)


For reprint and licensing requests for this article, CLICK HERE.