Understanding Health Insurance Laws
Monday, May 31st, 2010 by adminThe legal provisions surrounding health insurance are constantly changing and evolving. An individual that is well-versed in health insurance law will be better prepared to make important decisions involving health care. Here are several key provisions in health insurance law that all individuals should be familiar with.
In the area of mental health, parity has been an issue for some time. Mental health was recently placed on the same level as medical care where insurance coverage is concerned. Provisions are in place to ensure that an individual has the same level of access to care for mental and substance abuse services, as one would for medical treatment. The Mental Health Parity and Addition Equity Act of 2008 requires that the financial requirements and treatment limitations of group health plans be comparable to medical/surgical benefits. This important measure was enacted to give an individual access to affordable mental health services.
There are also important health insurance laws involving short term disability. Most states do not require short term disability coverage to be provided by an employer. Currently, there are only four states that require the employer to provide short term disability coverage. The four states are California, New Jersey, New York, and Rhode Island. It is important for individuals to become clear on what short term disability coverage is available through the health insurance plans provided by their employers.
During this period of economic uncertainty, many individuals will become reliant on COBRA for health care coverage. Many people will struggle with the provision regarding qualifying events. Qualifying events for employees include a reduction in hours or any termination not related to misconduct. Qualifying events for the spouse of the employee include the previous two conditions and other factors. Divorce, legal separation, Medicare eligibility and death of the covered employee are all treated as qualifying events.
Another key issue involving health insurance laws is cancellation of policies. The bigger issue is the circumstances under which an insurance company can cancel one's coverage. The insurance carrier can cancel coverage on the grounds of material omission or misrepresentation made during the application process. An individual must answer all questions in the application process with honesty to prevent a policy cancellation during a period when coverage is needed the most.
The key to understanding health insurance laws is remaining current on specific policies and insurance terminology used by the industry. Information empowers an individual to make sound decisions regarding health care. Universal healthcare has been a goal for this nation for years. Universal healthcare was created to increase the level of accessibility of care for individuals that would fall into high risk pools, or would be unable to receive affordable coverage outside of employer-related plans.

