HIPPA or “The Health Insurance Portability and Accountability Act of 1996” was enacted on Aug. 21, 1996. The focus was to improve portability and continuity of health coverage. It contains provisions that:
- Provide individuals with additional rights through its pre-existing condition, special enrollment, and nondiscrimination requirements,
- Impose insurance market rules that apply to health insurance carriers which require guaranteed availability and renewability of health insurance plans,
- Govern the privacy and security of health information, and
- Require that claims information be exchanged in a standardized format.
Who and what kind of benefit has to comply with HIPAA? Insured and self-funded Group Health Plans and health insurance carriers that offer group Health Insurance Coverage must comply with HIPAA’s pre-existing condition, special enrollment, and nondiscrimination requirements. Prior to health care reform, self-funded, non-federal governmental plans were permitted to opt out of HIPAA’s portability and nondiscrimination requirements, but were still required to issue Certificates of Creditable Coverage. This took effect on Sept. 23, 2010.
Most Excepted Benefits do not constitute Health Insurance Coverage therefore the do not have to comply with HIPPA. Coverage’s include but are not limited to:
- Coverage only for accident (including accidental death and dismemberment),
- Disability income coverage,
- Liability insurance, including general liability insurance and automobile liability insurance,
- Coverage issued as a supplement to liability insurance,
- Workers’ compensation or similar coverage,
- Automobile medical payment insurance,
- Credit-only insurance (for example, mortgage insurance), and
- Coverage for on-site medical clinics.
HIPAA also requires that Group Health Plans and Health Insurance Coverage issuers recognize Special Enrollment Periods beyond open enrollment or new employment. If an individual applies for coverage during a Special Enrollment Period, he or she may not be treated as a Late Enrollee. HIPAA provides for Special Enrollment in the following situations
- Loss of Eligibility for other coverage
- Marriage, Birth or Adoption
- Loss of eligibility for other coverage subsequently obtained after initial enrollment.
- Eligibility for Assistance.
- Loss of eligibility for other coverage subsequently obtained after initial enrollment.
- Moving Outside the HMO Service Area.
- Lifetime Benefit Limits.
