US Department of Health & Human Services
www.hhs.gov/hipaa/
HIPAA condensed - Wikipedia
Health Insurance Portability and Accountability Act
From Wikipedia, the free encyclopedia
.svg) | |
| Other short titles | Kassebaum–Kennedy Act, Kennedy–Kassebaum Act |
|---|---|
| Long title | An Act To amend the Internal Revenue Code of 1986 to improve portability and continuity of health insurance coverage in the group and individual markets, to combat waste, fraud, and abuse in health insurance and health care delivery, to promote the use of medical savings accounts, to improve access to long-term care services and coverage, to simplify the administration of health insurance, and for other purposes. |
| Acronyms(colloquial) | HIPAA (pronounced /ˈhɪpə/, HIP-uh) |
| Enacted by | the 104th United States Congress |
| Citations | |
| Public law | Pub.L. 104–191 |
| Statutes at Large | 110 Stat. 1936 |
| Legislative history | |
| |
The Health Insurance Portability and Accountability Act of 1996 (HIPAA; Pub.L. 104–191, 110 Stat. 1936, enacted August 21, 1996) was enacted by the United States Congress and signed by President Bill Clinton in 1996. It has been known as the Kennedy–Kassebaum Act or Kassebaum–Kennedy Act after two of its leading sponsors.[1][2] Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs.[3] Title II of HIPAA, known as the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers.[4]
Contents
[hide]- 1Title I: Health Care Access, Portability, and Renewability
- 2Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification; Medical Liability Reform
- 3HITECH Act: Privacy Requirements
- 4Effects on research and clinical care
- 5HIPAA and drug and alcohol rehabilitation organizations
- 6Violations of HIPAA
- 7Title III: Tax-related health provisions governing medical savings accounts
- 8Title IV: Application and enforcement of group health insurance requirements
- 9Title V: Revenue offset governing tax deductions for employers
- 10Legislative information
- 11References
- 12External links
Title I: Health Care Access, Portability, and Renewability[edit]
Title I of HIPAA regulates the availability and breadth of group health plans and certain individual health insurance policies. It amended the Employee Retirement Income Security Act, the Public Health Service Act, and the Internal Revenue Code.
Title I requires the coverage of and also limits restrictions that a group health plan can place on benefits for preexisting conditions. Group health plans may refuse to provide benefits relating to preexisting conditions for a period of 12 months after enrollment in the plan or 18 months in the case of late enrollment.[5] Title I allows individuals to reduce the exclusion period by the amount of time that they had "creditable coverage" prior to enrolling in the plan and after any "significant breaks" in coverage.[6] "Creditable coverage" is defined quite broadly and includes nearly all group and individual health plans, Medicare, and Medicaid.[7] A "significant break" in coverage is defined as any 63-day period without any creditable coverage.[8] Along with an exception, allowing employers to tie premiums or co-payments to tobacco use, or body mass index.
Title I[9] also requires insurers to issue policies without exclusion to those leaving group health plans with creditable coverage (see above) exceeding 18 months, and [10] renew individual policies for as long as they are offered or provide alternatives to discontinued plans for as long as the insurer stays in the market without exclusion regardless of health condition.
Some health care plans are exempted from Title I requirements, such as long-term health plans and limited-scope plans such as dental or vision plans that are offered separately from the general health plan. However, if such benefits are part of the general health plan, then HIPAA still applies to such benefits. For example, if the new plan offers dental benefits, then it must count creditable continuous coverage under the old health plan towards any of its exclusion periods for dental benefits.
An alternate method of calculating creditable continuous coverage is available to the health plan under Title I. That is, 5 categories of health coverage can be considered separately, including dental and vision coverage. Anything not under those 5 categories must use the general calculation (e.g., the beneficiary may be counted with 18 months of general coverage, but only 6 months of dental coverage, because the beneficiary did not have a general health plan that covered dental until 6 months prior to the application date). Since limited-coverage plans are exempt from HIPAA requirements, the odd case exists in which the applicant to a general group health plan cannot obtain certificates of creditable continuous coverage for independent limited-scope plans such as dental to apply towards exclusion periods of the new plan that does include those coverages.
Hidden exclusion periods are not valid under Title I (e.g., "The accident, to be covered, must have occurred while the beneficiary was covered under this exact same health insurance contract"). Such clauses must not be acted upon by the health plan and also must be re-written so that they comply with HIPAA.