Health Insurance Portability and Accountability Act...

By: Taylor


The Health Insurance Portability and Accountability Act or HIPAA is a federal law. It offers protections to millions of workers and provides portability and continuity of health insurance coverage. It was passed in 1996. Later administrative simplification provisions of the act led to adoption of national standards for electronic health care transactions and national identifiers for providers, health plans, and employers by the Department of Health and Human Services (HHS). The Affordable Care Act added new requirements to adopt in HIPAA. It asks for operating rules for each of the HIPAA covered transactions, a unique, standard Health Plan Identifier (HPID) and a standard and operating rules for electronic funds transfer (EFT) and electronic remittance advice (RA) and claims attachments. Health Plans also need to certify their compliance.

It provides additional opportunities to enroll in a group health plan in case of loss of coverage. It provides protection against loss of coverage for a pre-existing condition. HIPAA does not require employers to offer health coverage. It does not guarantee coverage of pre-existing condition by new employer’s health plan and it does not prohibit an employer from imposing a pre-existing condition exclusion period in case of any condition being treated for a condition during the past 6 months. Benefits offered by HIPPA are discussed below.

Workers and Their Families

It limits exclusions for pre-existing medical conditions and provides credit against maximum pre-existing condition exclusion periods. It also allows individuals to enroll for health coverage on loss of other health coverage, getting married or adding a new dependent. It also prohibits discrimination in enrollment and in premiums charged. It guarantees health insurance coverage for small employers and renewability of health insurance coverage for all employers whether small or large.

Pre-existing Condition Exclusions

The pre-existing condition is a condition in which medical advice, diagnosis, care, or treatment was recommended or received during the 6-month period prior to an individual’s enrollment date. Under HIPAA, a plan is allowed to look back only 6 months for a condition for coverage in a group health plan.

A pre-existing condition can be excluded from plan coverage only for 12 months and 18 months for late enrolees. Some plans may have a shorter time period or none at all.

Special Enrollment Rights

It offers special rights to coverage to individuals who lose coverage due to separation, divorce, death, termination of employment and reduction in work hours. It also offers coverage when employer contributions toward the other coverage terminates. It ensures coverage to employees, their spouses and new dependents upon marriage, birth, adoption or placement for adoption. It also guarantees individuals to have access to individual health insurance policies and their renewal.

Discrimination Prohibitions

HIPPA ensures that no one is excluded from coverage or denied benefits or get charged more for coverage based on any on health status or issues. It prohibits discrimination against employees and their dependent family members on basis of any prior medical conditions, previous claims experience or genetic information.

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