Disenrollment

The term disenrollment is used for an insured member dropping his or her insurance coverage. This may occur when the individual leaves a job and goes to another or when the premiums are too costly to maintain. Medicare and Medicaid beneficiaries may “trade” their traditional Medicare/Medicaid benefits and sign them over to a managed care company. They thus disenroll from Medicare to go to another insurance plan.

Typically, the Medicaid beneficiary may disenroll up to three times in a given period without penalty.

The ability to make changes or the need to make changes in insurance coverage has caused some concerns in the federal government.

Getting information about health care status, the sharing of this information, and “pre-existing condition” exclusions have caused serious difficulties for many people. As a result, the federal government has passed the Health Information Portability and Accountability Act (HIPAA), which provides legal guardianship for protected health information, and limits how that information is shared and with whom. There are three areas of focus: privacy, security, and administrative simplification. In each of these focus areas, there are very specific responsibilities that all health care providers, associates, vendors, and others who have real or potential access to protected health care information are obliged to address and carry out.

As HIPAA touches on every aspect of health care, compliance with the changes is expected to cost millions of dollars.