As important as they are, the federal and state health insurance reforms are limited. Therefore, you also should understand how the laws do not protect you.

• If you change jobs, you usually cannot take your old health benefits with you. Except when you exercise your federal COBRA rights or state continuation rights, you are not entitled to take your actual group health coverage with you when you leave a job. Your new health plan may not cover all of the benefits or the same doctors that your old plan did.
• If you change jobs, your new employer may not offer you health benefits. Employers are required only to make sure that any health benefits they do offer do not discriminate based on health status.
• If you get a new job with health benefits, your coverage may not start right away. Employers can impose waiting periods before your health benefits begin. HMOs can require affiliation periods.
• If you have a break in coverage of 63 days or more, you may have to satisfy a new pre-existing condition exclusion period when you join a new group health plan.
• Even if you have continuous coverage, there may be a pre-existing condition exclusion period for some benefits if you join a group health plan that covers certain benefits your old plan did not. For example, say you move from a group plan that does not cover prescription drugs to one that does. You may have to wait up to one year before your new health plan will pay for drugs prescribed to treat a pre-existing condition.
• If you work for certain non-federal public employers in DC, not all of the group health plan protections may apply to you.
• If you are not HIPAA eligible, individual health insurers in D.C., other than CareFirst Blue Cross Blue Shield, are free to turn you down because of your health status and other factors. In addition, CareFirst Blue Cross Blue Shield can turn you down if you apply for a non-guaranteed issue policy.
• Even if you are HIPAA eligible, you can be turned down for some individual health insurance policies. The law permits individual insurers to limit your choices to two plans, which are supposed to be comparable to others they sell in the individual market in D.C.
• In general, there are no limits to what insurers can charge you for individual health insurance. You can be charged substantially higher premiums because of your health status, age, gender, and other characteristics.
• If you move away from D.C., you may not be able to buy individual health insurance in another state unless you are HIPAA eligible.
• If you are a small employer buying a group health insurance policy, you can be charged more, generally without limits, based on the health status, age, gender, and other factors of those in your group. In turn, premiums can be significantly higher if someone in your group has a serious illness.