Individual Market Health Insurance Reform--Portability from Group to Individual Coverage, Federal Rules for Access in the Individual Market, and State Alternative Mechanisms to Federal Rules

OGC-97-38: Published: Apr 24, 1997. Publicly Released: Apr 24, 1997.


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Pursuant to a legislative requirement, GAO reviewed the Department of Health and Human Services' (HHS) new rule on the portability of individual health insurance from group to individual coverage, access to the individual insurance market, and state alternative mechanisms to federal rules. GAO noted that: (1) the new rule would implement section 111 of the Health Insurance Portability and Accountability Act of 1996 to improve access to the individual insurance market by ensuring that certain eligible individuals who lose group coverage can obtain individual coverage on a guaranteed basis without preexisting condition exclusions; (2) the new rule would make all individual health insurance coverage guaranteed renewable; (3) the rule would also set forth procedures that apply to states that choose to implement a mechanism under state law, as an alternative to the federal requirements with respect to guaranteed availability for eligible individuals and the rules that apply if a state does not substantially enforce the statutory requirements; and (4) HHS complied with applicable requirements in promulgating the rule.

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