Rights and Protections
As a health insurance consumer, you have certain rights and protections. Many of these rights vary by state. Under the Affordable Care Act your rights and protections are expanding and will continue to do so through 2014 and beyond.
What should I know if I have individual health insurance?
The state you live in matters
If you buy insurance for yourself, many of your rights and protections vary based on the state you live in.
- In most states, insurers can decide what kind of policy to offer you. They can turn you down for coverage, offer you a very expensive policy, or offer you a policy that doesn’t cover your pre-existing condition, including a disability.
- In a handful of states, insurers that sell individual health insurance can’t turn you down because of your health status, disability, or other factors. Contact your State Department of Insurance to see if this protection applies to you.
Rights and protections under individual coverage
The Affordable Care Act has added new rights and protections for all consumers, including greater access to individual health insurance policies.
- As of September 2010, new individual policies (and work-based plans) aren’t allowed to turn children down because of a pre-existing condition, including a disability. Starting in 2014, these same plans won’t be able to turn down anyone who has a pre-existing condition, including a disability.
- If your child is under age 26, he or she can remain covered under your policy. Under the Affordable Care Act, private health insurance that offers dependent coverage must allow parents to cover their children until age 26. Your children don’t need to live with you to be eligible for this coverage.
- Once you (and your family) have an individual health insurance policy, it cannot be canceled or discontinued when you or a family member get sick.
- The Affordable Care Act protects you against insurance companies dropping your coverage when you get sick only because you made a mistake on your coverage application.
Contact your State Department of Insurance for more information about your rights and protections under individual health insurance.
What should I know if I have insurance through work?
- Nondiscrimination: If your employer offers coverage, you generally can’t be turned away or charged a higher premium because of your health status or disability. This protection is called “nondiscrimination.”
- Special enrollment: If family members are eligible but not now enrolled under your health plan at work, you may be able to add them to your coverage during a “special enrollment” opportunity outside of open enrollment. You and your family members can qualify for a special enrollment opportunity following certain life events, such as marriage or the birth or adoption of a child. Loss of other coverage can trigger a special enrollment opportunity.
- Health insurance under family and medical leave: If you need to take time off from work because of a serious illness or disability, to care for another family member, or to have or adopt a child, you may qualify for leave under the Family and Medical Leave Act. If so, your employer must continue your health benefits while you’re on leave. Ask your benefits administrator whether you qualify.
- Coverage for young adults: If your child is under age 26, he or she may be able to be covered under your policy. Private health insurance that offers dependent coverage generally must allow parents to cover their children until age 26. Your children don’t need to live with you to be eligible for this coverage. Before 2014, if they’re eligible for health benefits from their own job, your existing job-based plan may not have to cover them.
What if I’m losing work-based coverage?
See “What if I’m losing work-based coverage?”
How can I learn more about my rights and protections?
Read the Patient’s Bill of Rights under the Affordable Care Act, which lays out all of the law’s rights and protections.
For more information about the health insurance marketplace, see Insurance Basics.