Limitations

• The law prevents the inclusion of a preexisting inclusion for group health insurance plans based on specific criteria. This includes the status of an individual's health, medical history as well as a disability or any type of health information, such as a genetic marker. HIPAA also has limitations such as not guaranteeing the same level of benefits from a previous group health plan. The law was only designed to provide protection against a waiting period for coverage if a preexisting condition exists.
  
  

Requirements

• HIPAA does have certain requirements that need to be met in order for a preexisting condition to not apply. This includes having a health insurance plan in place without a significant lapse of coverage for at least 12 months. If this condition is met, a new group insurance plan is required to cover medical expenses as soon as an individual has enrolled in the group plan.
  
  

Illnesses or Injury

• HIPAA sets certain types of illnesses that cannot be included in a preexisting exclusion that is used for health coverage. These include pregnancy, conditions present in a newborn or adopted child or genetic markers. Pregnancy is a condition that cannot be excluded from coverage in a new group plan even if no prior coverage existed. A condition that is present in a newborn child or adopted child under 18 cannot be excluded if the child is enrolled within 30 days of birth or adoption. Genetic information also cannot be included in a preexisting exclusion unless a disease has been diagnosed.
  
  

Rights

• HIPAA does not require employers to carry health insurance coverage. The rules for this act apply to every employer that has a group plan with at least two members. Some states can also apply HIPAA rules to a "group" of one that can help many self-employed individuals. The rights guaranteed under HIPAA do not apply when an individual switches from one individual health plan to another.
  
  

Coverage

• Coverage for group health plans under HIPAA require continuous coverage in order for a preexisting exclusion to not apply. There can be breaks in coverage but they cannot be longer than 63 days. Any amount of time that an individual had group coverage before a break can be used to offset a preexisting exclusion, providing it is not more than 63 days.