Summary: Minimum standards of protection now apply to group (both fully insured and self-funded) and individual insurance coverage sold in all states. As a result, many consumers face fewer exclusions for preexisting conditions, enrollees should be able to more easily renew their health plans, employees may not be excluded from group health plans on the basis of their health status, small employers must have guaranteed access to all coverage sold in the small group market, and high-risk individuals losing group coverage may have better access to either individual health insurance or a subsidized high-risk pool. Nonetheless, high-risk individuals and some small groups may continue to face high premiums for guaranteed coverage, and relatively few high-risk individuals who lost group coverage appear to have purchased individual insurance guaranteed by the Health Insurance Portability and Accountability Act of 1996. Consumers' lack of awareness or understanding of the act can impede their ability to exercise their rights. One potentially effective education tool is the certificate of creditable coverage that must be issued to every enrollee who loses insurance coverage. However, guidance on this certificate does not explicitly and comprehensively outline the law's protections. Both the Health Care Financing Administration (HCFA) and the Department of Labor recognize that further efforts are needed, including targeting consumer education efforts, proactively ensuring employers' compliance, and ensuring that all states' insurance regulations fully conform with federal standards. Moreover, HCFA recognizes that its ability to fully perform its new regulatory role will be enhanced when enforcement regulations are issued.
