The HIPAA plan is a Preferred Provider Organization (PPO) plan available only to federally eligible individuals who qualify for coverage because they have had prior creditable coverage and meet the other HIPAA requirements. To received maximum benefits under the plan, a designated PPO provider must be used. The HIPAA plan has two deductible options to choose from: $2,500 and $5,000.
A six-month pre-existing condition limitation does not apply to the HIPAA plan. The HIPAA plan is a Preferred Provider Organization (PPO) plan available only to federally eligible individuals who qualify for HIPAA coverage. To receive maximum benefits under this plan, a participating PPO provider must be used.
Federally eligible individuals in the individual market are those who, at the time they seek individual coverage, satisfy all of the following criteria: they must have accrued a total of 18 or more months of prior creditable coverage; they have no more than a 90 day break between periods of creditable coverage; their most recent creditable coverage must have been provided under a group health plan, governmental plan or church plan; they must not be eligible for group health coverage, Medicare or Medicaid, and must not have any other health insurance coverage; their most recent coverage must not have been terminated due to nonpayment of premium or fraud; and, if offered continuation of coverage under federal COBRA requirements or state continuation laws, they must have elected and exhausted such continuation coverage.