How Am I Protected?

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In California, as in many other states, your health insurance options are somewhat dependent on your health status. Even if you are sick, however the laws protect you in the following ways.

· Coverage under your group health plan (if your employer offers one) cannot be denied or limited, nor can you be required to pay more, because of your health status. This is called nondiscrimination. (see Group Health Plans)

· All health plans in California must limit exclusion of pre-existing conditions. There are rules about when a pre-existing condition exclusion period can be applied and how long you must wait before a new health plan will begin to pay for care for that condition. Generally, if you join a new health plan, your old coverage will be credited toward the pre-existing condition exclusion period, provided you did not have a long break in coverage. (see Group Health Plans for Group Coverage, and Individual Health Plans for Individual Coverage)

· Your health insurance cannot be canceled because you get sick. Most health insurance is guaranteed renewable. (see Individual Health Plans for Individual Coverage, and Small Employer or Self-Insured Person for Small Group Coverage)

· If your son or daughter is in college and covered as a dependent under your group, but cannot maintain student status due to illness, he or she may still be able to remain covered as your dependent for up to one year. (see Group Health Plans)

· If you leave your job, you may be able to remain in your old group health plan for a certain length of time. This is called COBRA or Cal-COBRA coverage. It can help when you are between jobs, or when you retire early and are not yet eligible for Medicare. There are limits on what you can be charged for this coverage. (see Individual Health Plans)

· If you lost your group health plan because of involuntary termination of employment that occurred between September 1, 2008 and December 31, 2009, you may be eligible for a federal tax credit that can help you pay for your COBRA or state continuation coverage premiums for up to nine months. (see Individual Health Plans)

· If you lose coverage under a fully insured group health plan in California, you may be able to buy a conversion policy. This is an individual policy from the company that insured your former group. You will not face a new pre-existing condition exclusion period under a conversion policy. (see Individual Health Plans)

· If you lose your group health plan and meet other qualifications, you will be HIPAA eligible. If so, you are guaranteed the right to buy an individual health insurance policy from any insurance company that sells individual coverage. You will not face a new pre-existing condition exclusion period. There are limits on what you can be charged for such a policy. (see Individual Health Plans)

· If you have had difficulty obtaining individual health insurance because of your health condition, you may be eligible for Major Risk Medical Insurance Program (MRMIP). You may face a new pre-existing condition exclusion period when you join. There are limits on what you can be charged for a MRMIP policy. (see Individual Health Plans)

· When you apply for an individual health insurance policy, insurance companies may not turn you down, charge you more or impose a pre-existing condition exclusion period because of your genetic information. In addition, insurance companies are not allowed to even ask about your genetic tests or family history when you apply for coverage. (see Individual Health Plans)

· If you are a small employer buying a fully insured small group health plan policy, you cannot be turned down because of the health status, age, or any factor that might predict the use of health services of those in your group. All fully insured health insurance policies for small employers must be sold on a guaranteed issue basis. (see Small Employer or Self-Employed Person)

· As a small employer, you cannot be turned down or charged more because of the genetic information of a member of your group. In addition, insurance companies are not allowed to even ask about genetic tests or family history of people in your group when you apply for coverage. (see Small Employer or Self-Employed Person)

· If you have low or modest household income, you may be eligible for free or subsidized health coverage for yourself or members of your family. The California Medi-Cal program (also called Medicaid) offers free health coverage for pregnant women, families with children, elderly and disabled individuals with very low incomes. (see Financial Assistance)

· If your children are under the age of 19, do not have health insurance and meet other qualifications, you may be able to get coverage for them through the Healthy Families program. (see Financial Assistance)

· If you have or are at risk for breast or cervical cancer, you may be eligible for free screening. The Every Woman Counts Program provides qualified women with free breast and cervical cancer screening. In addition, women diagnosed with cancer may be eligible for treatment through the Breast And Cervical Cancer Program (BCCTP). (see Financial Assistance)

· If you have breast or cervical cancer and meet certain income and insurance requirements, you may be eligible for free treatment. The Breast And Cervical Cancer Treatment Program (BCCTP) is a state and federally funded program that provides cancer treatment certain qualified residents of California who are in need of treatment for breast and/or cervical cancer. BCCTP serves both men and women. (see Financial Assistance)

· If you lost your health insurance and are receiving benefits from the Trade Adjustment Assistance (TAA) Program, then you may be eligible for a federal income tax credit to help pay for new health coverage. This credit is called the Health Coverage Tax Credit (HCTC), and it is equal to 80% of the cost of qualified health coverage, including COBRA. (see Financial Assistance)

·If you are a retiree aged 55-65 and receiving pension benefits from Pension Benefit Guarantee Corporation (PBGC), then you may also be eligible for the HCTC. (see Financial Assistance)


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