Michigan and Michigan Blue Cross Blue Shield HIPPA and other health related regulations, definitions etc.

First posted Fri 07/22/2011 01:57 PM

OFIR HOT LINE 877-999-6442

OFIR, Office of Financial and Insurance Regulation, is the State of Michigan agency responsible for regulating Michigan.s financial industries including consumer finance, financial institutions, insurance and securities.

The agency consists of over 350 professionals dedicated to protecting Michigan consumers by ensuring the companies that it regulates are financially solvent, follow state and federal law, and are entitled to the public confidence.

Conversion Rights

Unless your employer is self-insured, you may have the right to convert your group insurance certificate into individual coverage (called a group conversion policy) provided by the group's insurance company or HMO plan. Your benefits may be changed or the amount of benefit may be reduced for a specific covered service. Premiums may increase. However, you can keep the policy as long as you pay premiums. You have the right to convert your group policy to an individual policy with the same company if you have been continuously insured for at least three months in the group and:

You leave the employer, the group policy has been discontinued for all employees or for a specific class of employees, you are involuntarily terminated for reasons other than gross misconduct. You are a covered family member of a certificate holder who has died, You have reached the age limit for coverage under your parent's group coverage or You divorce or separate from the certificate holder. You must apply within 30 days of losing group coverage. Example: For the past five years you've worked for Joe's Hardware and your family has been insured by Old Reliable Insurance Company or HMO. Within 30 days after leaving the job you apply to Old Reliable for a group conversion policy. The group conversion policy might have fewer benefits and higher premiums than the group policy. Old Reliable must issue the policy regardless of your health. You can keep the group conversion policy as long as you pay premiums.

In Michigan, once you have converted your policy to an individual policy you are no longer a HIPAA eligible individual and will lose protections provided under this Act. Please see section on HIPAA protections.

Relevent personnel health insurance history

  1. Anthem started January 1, 2010
  2. Anthem continued with COBRA starting May 1,2010 and will continue through October 31, 2011
  3. Total time with Anthem is 22 months (This is 4 months January through April of 2010 while husband (Paul Pinkstaff) still worked for HP plus what will be 18 months of COBRA, May 2010 through October, 2011.)

What is credible coverage

The concept of creditable coverage is that individuals should be given credit for previous health coverage when moving from one employer group health plan to another, from an employer group health plan to an individual policy, or from certain kinds of individual coverage to an employer group health plan. Most health coverage is creditable coverage, including prior coverage under a group health plan (including a governmental or church plan), health coverage (either group or individual), Medicare, Medicaid, a military-sponsored health care program such as TRICARE, a program of the Indian Health Service, a State high risk pool, the Federal Employees Health Benefit Program, a public health plan, and a health benefit plan provided for Peace Corps members.

How HIPPA applies in Michigan

How does HIPAA apply if I am moving from a group plan to an individual plan? When leaving group insurance for an individual plan it will help to know if you are a "HIPAA eligible individual" If you qualify as a HIPAA eligible individual and are a resident of Michigan and apply for individual coverage with Blue Cross Blue Shield of Michigan, you cannot be turned down for coverage regardless of your health. If you have creditable coverage from the prior group policy, the number of months you had that coverage will be used to eliminate the pre-existing condition exclusion waiting period. For more information about Blue Cross Blue Shield of Michigan, please reference that section.

In Michigan, you can apply for coverage through any commercial health insurance carrier for individual coverage. However, they can underwrite your application and refuse coverage based on your health conditions. If they do choose to accept you as an insured, they can only exclude any pre-existing condition for up to 12 months.

Anthem HIPPA

Anthem rules California law say you must be a permanent resident of California to be eligible for a conversion under HIPPA. A conversion with Anthem is out!

Blue Cross Blue Shield of Michigan (BCBSM)

Does BCBSM provide coverage under HIPAA?

BCBSM is the alternative mechanism for individuals in Michigan who no longer have access to group health coverage. BCBSM will write an individual (non-group) policy for Michigan residents if they meet all of the following:

Must be HIPAA eligible by having at least 18 months of continuous group health coverage
Have accepted and exhausted all COBRA coverage they are entitled to.
Most recent coverage was group employment related.
Cannot have more than a 62-day gap in coverage.

If the above criteria is met and the person provides BCBSM with the certificate of creditable coverage from their last group health plan the 180-day waiting period for pre-existing conditions will be waived. Further information on HIPAA is available at http://www.michigan.gov/cis/0,1607,7-154-10555_12902_35510_35540---,00.html

Nonprofit Health Care Corporation Reform Act: Nonprofit Health Care Corporation Reform Act
Nonprofit Health Care Corporation Reform Act: Diabetes Coverage: BCBSM Diabetes Coverage
Patient's Right to Independent Review Act: Patient's Right to Independent Review Act
BCBSM Web Page - http://www.bcbsm.com/

BCBSM Application for waiver of pre-existing waiting period

Go directly to the application: Blue Cross and Blue Shield of Michigan Preexisting Condition Exclusion Rider Criteria for Waiver

MyBlue for instructions about applying for coverage


Possible HP contact lori.wolcik@hp.com. Found this name at an HP page titled Your Benefits by clicking on the left "Start a conversation," which gave me the e-mail address.