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3: Analyze Your Circumstances

Understand Your Health Care Rights

You have the following rights and protections as a health insurance purchaser and health care consumer:

Health Insurance Purchaser Health Care Consumer
Continuation of Coverage (COBRA). If you have insurance through an employer with 20 or more employees, you have the right to continue your health insurance for 18 months in case you leave or lose your job. There are three qualifications you must meet for COBRA, you must apply within a certain time and pay the full premium. Health Insurance Portability and Accountability Act (HIPAA) Privacy — Access to Health Records. Under HIPAA, you may request to view or receive copies of your health records (there may be a fee for copying). You may also request changes, corrections and additions to your health record.
Health Insurance Portability and Accountability Act (HIPAA). In addition to guarding your health privacy, this legislation protects coverage for workers (and their families) in case of job loss or job change. This was an especially important advancement for individuals with pre-existing conditions who previously could be denied coverage for their condition(s). Health Insurance Portability and Accountability Act (HIPAA) — Privacy. The HIPAA Privacy Rule protects your private health information in written, spoken or electronic formats. Under this rule, you specify who can access your health information.
Policy Cancellation. In the past, insurance companies could cancel your policy if you made a mistake in the application. Under current law, this is not permitted if you make a mistake or leave out information that is not relevant to your health. If you purposely mislead the company, however, your coverage can be cancelled retroactive to the time a claim was filed. Informed Consent. You have the right to receive information and ask questions about your treatment. Prior to engaging in a treatment plan, health care providers must provide you and/or your surrogate information about your diagnosis, recommended treatments and risks/benefits. This consent must be documented in your records.

gavelThere are numerous other rights and protections you have as a health care consumer. Check them out at Health care.gov. Additionally, many states have their own laws, especially those related to balance billing. Use this map to locate your state insurance division and discover helpful information specific to your state.

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