She mentions her concern to a friend, who suggests she talk to someone in the PR firm’s human resources department. Michelle calls the person she interviewed with, who refers her to Jacqui, a human resources manager with the company.

The two sit down to meet one morning, and Michelle explains her concerns. Jacqui quickly alleviates some of her fear.

“First of all,” explains Jacqui, “it would be illegal for our health plan to deny you coverage because of the status of your health. It doesn’t matter if you have MS, cancer, or some condition that costs of tens of thousands of dollars per month to treat. The federal Health Insurance Portability and Accountability Act (HIPAA) and similar California regulations guarantee you access to our group health care plan.”

“Well, that’s a relief,” says Michelle. “What about my son? Will he be covered? He was covered under my previous employer’s plan.”

“Absolutely,” says Jacqui. “For companies like ours that offer coverage to our employees’ dependents, HIPAA guarantees both you and any of your dependents access to employer-sponosered health coverage when you’re changing jobs.”

“Oh, that is fantastic!” says Michelle.

“That’s the good news,” says Jacqui. “The bad news is that you can temporarily be denied coverage for your multiple sclerosis.”

“What do you mean ‘temporarily’?” Michelle asks worriedly.

“Well, like I said, our health care provider cannot deny you access to their plan altogether. That would be against HIPAA and California regulations. But they can refuse to pay for medical costs associated with your MS for the first 6 months you work here. That’s called a pre-existing condition exclusionary period.”

“A pre-existing condition exclusionary period?”

“Yes. A pre-existing condition is any health condition you were diagnosed with or treated for within six months prior to starting your new plan,” says Jacqui. “In California, fully-insured employer-sponsored health care providers can refuse to pay for treatment of a pre-existing condition like your MS for up to 6 months when you start a plan; 12 months, if you miss enrollment deadlines.”

“Well that’s just horrible,” says Michelle. “This was my dream job and now I’m not going to be able to take it. I can’t afford to pay for my MS expenses for 6 months. I’m going to have to stay at my old job.”

“Not necessarily,” says Jacqui. “There are ways you can reduce or get rid of that pre-existing exclusionary period altogether. How long have you worked at your current job?”

“Three years,” says Michelle.

“And have you been covered under their health plan that entire time?”

“Yes.”

“Well, that settles it,” says Jacqui. “As long as you were covered under their plan for 6 months, you have enough creditable coverage to wipe out any pre-existing exclusionary period. You’d be covered from the first day you enroll in our plan.”

“You’re kidding,” exclaims Michelle. “Just like that?”

“Just like that,” says Jacqui.

“How can you be sure my old plan qualifies as ‘creditable coverage’?” Michelle asks.

“Many forms of health coverage qualify,” says Jacqui, “including private employer-sponsored, association-sponsored or individual health plans, continuation coverage, or public benefits like Medi-Cal and Medicare coverage. So, in your case, three years of coverage under your employer’s group plan equals three years of creditable coverage. That’s more than enough to wipe out any 6 month exclusionary period.”

“That is fantastic,” says Michelle. “I am so relieved. Now, let me make sure I heard you correctly. Did you say Medi-Cal coverage be used to reduce that 6 month period.”

“That’s right,” says Jacqui. “Coverage under public benefits like Medi-Cal and Medicare qualify as creditable coverage.”

“That is very interesting. I need to let some of my friends know about this,” says Michelle.

“Absolutely. You might tell them to contact a benefits planner to answer any questions they might have,” says Jacqui.

“Now, assuming I take this position with your company—and I’m sure I will,” says Michelle, “I’m going to have a five-week period in between jobs. What do I do about health coverage during that period?”

“Your old employer may have to provide you access to continued health coverage under COBRA. You’ll pay the full cost of the premiums during the time. That’s certainly a viable option,” says Jacqui.

“That’s good to know.”

“One thing to remember,” says Jacqui. “If for some reason you go without health coverage while you’re in between jobs, make sure you don’t do so for more than 180 days. The limit is usually 63 days, but since we’re a fully-insured plan, and your previous coverage was employer-sponsored, and you lost that coverage because your job ended, California law extends the limit to 180 days. If you have a break in coverage of more than 180 days, the creditable coverage you accumulated under your previous employer’s plan will be wiped out and you could be subject to a pre-existing exclusionary period.”

“180 days. OK. I don’t want to go even one day without health coverage, but I’m glad to know about this time limit,” says Michelle. “Now, I have one other question for you. When can I enroll in your health plan?”

“The first day you start working here. Our usual open enrollment period is September through October, but because you’re a new employee, we offer special enrollment at the time you start with us. That’s another HIPAA protection.”

“Thank goodness for HIPAA,” says Michelle.

“I agree,” says Jacqui.