Important Note: Below is only an excerpt from the HIPAA section of the 2007 For Your Benefit book. For more information about the For Your Benefit book, please contact a CBIZ representative.
Health Insurance Portability, Privacy and Other Rights
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) limits the time that an individual can be excluded from health coverage due to a health condition that pre-dates the effective date of coverage, known as a preexisting condition. Another significant component of HIPAA is the ability for an individual to move from one comprehensive health plan to another, without having to satisfy an exclusionary period for prior conditions, as long as the individual does not go without coverage for 63 days or more.
The Newborns' and Mothers' Health Protection Act of 1996 and the Mental Health Parity Act of 1996 contain provisions addressing maternity in-hospital length of stay and mental health coverage. The Women's Health and Cancer Rights Act provides coverage for breast reconstructive surgery following a mastectomy.
The HIPAA Administrative Simplification Rules (privacy, EDI and security) provide administrative guidelines and safeguards for protecting the confidentiality of medical information.
- HIPAA Portability Rules
The HIPAA Portability Rules provide for:- Access;
- Portability;
- Preexisting condition exclusion (PCE) limitations;
- Nondiscrimination in health status; and
- Guaranteed renewability.
Plans Subject to HIPAA
- Individual health policies.
- Group health plans, including HMOs and self-insured plans.
If certain conditions are met, the following plans may be partially exempt from the HIPAA portability rules:
- Small plans (<2 participants).
- Certain church plans.
- Federal government plans, although, they may be subject to parallel portability and nondiscrimination provisions contained in the Public Health Services Act, and
- Certain nonfederal (state) government plans are exempt from some HIPAA requirements, such as preexisting condition exclusion limitations, special enrollment periods, etc.
Plans Exempt from HIPAA. If certain conditions are met, the following plans are exempt from HIPAA
- Salary reduction flexible medical spending accounts, as long as the employer offers other coverage subject to HIPAA.
- Health savings accounts that are not subject to ERISA.
- Retiree health plans covering no current employees.
- Limited benefit plans, such as accident-only coverage, disability income, liability insurance, workers’ compensation, credit only, or on-site medical clinic coverage.
- Limited scope dental benefits, vision benefits, or long term care benefits, if they are provided under a separate policy or contract, and are otherwise not an integral part of a group health plan.
- Non-coordinated benefits, such as coverage for specified disease or illness, hospital indemnity insurance, or fixed dollar indemnity insurance, as long as they meet certain criteria.
- Supplemental benefits, such as Medigap or TRICARE.
