Question:

What is the Health Insurance Portability and Accountability Act (HIPAA)? How does it relate to employer responsibilities when offering a group health plan?

Answer:

The Health Insurance Portability and Accountability Act (HIPAA) places limitations on a group health plan’s ability to impose pre-existing condition exclusions, provides special enrollment rights for certain individuals, and prohibits discrimination in group health plans based on health status.

HIPAA is a federal law that:

  • Limits the ability of a new employer plan to exclude coverage for pre-existing conditions.
  • Provides additional opportunities to enroll in a group health plan if you lose other coverage or experience certain life events.
  • Prohibits discrimination against employees and their dependent family members based on any health factors they may have, including prior medical conditions, previous claims experience, and genetic information.
  • Guarantees that certain individuals will have access to, and can renew, individual health insurance policies.

HIPAA is complemented by state laws that, while similar to HIPAA, may offer more generous protections.

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