Health Insurance Laws Overview

Health insurance legislation varies from state to state, though federal laws apply across the board. To understand which laws are relevant to you  — especially with the complexity of health reform — we have compiled some resources to explain the variety of laws regarding health insurance.



The Patient Protection and Affordable Care Act has made changes to medical care since it was signed into law in 2010. Its landmark provisions help individuals gain coverage and not experience discrimination when applying for a plan. Health insurance is now regulated by the federal government under this law, with provisions ensuring coverage doesn’t get too costly and people have access through the state and federally-run exchanges. Separate from health reform, programs such as the Children’s Health Insurance Program (CHIP) were newly regulated in 2009 to provide services for more children and families that otherwise could not have afforded them.

A very important law that applies to every American is the Health Insurance Portability and Accountability Act (HIPAA). It focuses on the availability of group and individual health plans, medical care fraud prevention, privacy, and confidentiality of health-related information. The 1996 Health Insurance Portability and Accountability Act prohibits both issuers of health insurance policies and administrators of managed care plans from discriminating against any person on the basis of health factors. (See 42 USC Sec. 300gg-1(a) and Title 29 of the Code of Federal Regulations Section 2590.702 (29 C.F.R. Sec. 2590.702).)

No person can be denied eligibility for health insurance or participation in a managed care plan or charged a higher premium based on his or her medical condition (including physical and mental illness), claim receipt of health care, medical history, genetic information, or evidence of insurabililty or disability. Employers with over 50 full-time workers (30 hours or more per week) are required by law to offer health care coverage to their employees under the employer mandate. Group and individual plans are prohibited from discriminating against certain services, and cannot issue exclusions.

Life changes, such as a divorce, can alter the way your health insurance works. Your access to health care can get complicated depending on the benefits you and your children were receiving prior to the divorce.
Each state has it own legislation on health insurance availability and expenses. Some laws protect the patient, and others favor the health insurance company. Laws are constantly changing as states are either adopting or rejecting various health reform mandates. In order to understand the current laws in your region of the country, reference the guide below.


State by State Health Insurance Law



In each state, health insurance companies are required to include a provision in every health care plan known as guaranteed renewability. This provision ensures the policyholder receives medical benefits as long as they pay their premiums.

Pre-existing condition laws have been eliminated in every state. Health plans cannot increase your rates or isssue an exclusion period for any length of time because of your illness(es).
For further information or to answer any questions you may have, consult one of our knowledgeable agents at 888-803-5917.