HIPAA
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Introduction to HIPAA
In 1996, Congress passed The Health Insurance Portability and Accountability Act, now commonly known as HIPAA. HIPAA compliance is monitored by the Office for Civil Rights within the Department of Health & Human Services. Like COBRA, the Consolidated Omnibus Budget Reconciliation Act of 1985, HIPAA is a federal act regulating insurance policies. Although both acts affected continuation of health insurance coverage, the two bills were passed more than a decade apart, and with different emphases. Unlike COBRA, HIPAA does not guarantee continued health insurance coverage after an individual has left the company that provided his or her medical insurance. Rather, HIPAA addresses privacy issues regarding patient data and limits insurance companies from denying claims on those with pre-existing conditions.
Provisions of HIPAA
- Limits the ability of a new employer plan to exclude coverage for preexisting 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; and
- Guarantees that certain individuals will have access to, and can renew, individual health insurance policies.
The Initial Effects of HIPAA Legislation: Patient Privacy Issues
Although the formal title of the HIPAA legislation, The Health Insurance Portability and Accountability Act, does not include the term “privacy,” issues of patient medical privacy were the first issues addressed when the bill passed into law. Early articles addressed this issue exclusively: A September 2002 article by Helen Osborne, President of the firm Health Literacy Consulting, published an article about the new law in both The Boston Globe’s On Call magazine and her company’s website. Titled “In Other Words … How the New HIPAA Regulations Affect Healthcare Communication,” Osborne detailed the interventions considered necessary to protect patient privacy within the then-current healthcare framework. Procedures we have long grown accustomed to, such as consents to release medical records, are mandated and the consequences of failure to abide by the regulations are outlined.
Limitations of HIPAA
- Does not require that employers offer health coverage
- Does not guarantee that any conditions you now have (or have had in the past) are covered by your new employer's health plan
The Current Direction of HIPAA Legislation Emphasis: Medical Insurance Portability and Insurance Provider Accountability
The HHS’s OCR department continues to monitor patient privacy issues zealously, particularly with the current transition of paper medical records to electronic health records. HHS is now also focusing on Portability. The U.S. Department of Labor’s Employee Benefits Security Administration provides a succinct yet detailed definition of this current aspect of HIPAA enforcement:
Using COBRA and HIPAA to extend health coverage
COBRA can provide a temporary extension of your health coverage – as long as you and your family members, if eligible, belonged to the previous employer’s health plan and generally the employer had 20 or more employees. Usually, you pay at a minimum the entire cost of coverage, but not more than 102%. COBRA coverage lasts up to 18 months for most people, although it can continue as long as 36 months in some cases.
COBRA BENEFITS AND LIMITS
| Benefit | Limit |
|---|---|
| Breaks between Coverage | COBRA coverage can help you avoid a significant break between periods of health plan coverage. For example, if you expect to have a 6-month interruption between jobs and health plans, you can purchase COBRA coverage during that time. |
| Creditable Coverage | COBRA coverage can be counted as creditable coverage – as long as there is no significant break after your COBRA coverage ends. Creditable coverage can be used to offset any preexisting condition exclusion period you or a family member might have. |
| Pre-Existing Condition Exclusions | COBRA continuation coverage can be used as a bridge to ensure that you remain covered during a waiting period or a preexisting condition exclusion period. |
| Group Health Plans | If you have COBRA and become covered under other group health plan coverage that is not subject to a preexisting condition exclusion period, your COBRA coverage can be cut off. |
| Payment of Premiums | If you voluntarily stop COBRA coverage or stop paying your COBRA premiums, you will no longer be eligible for special enrollment. |
The introduction of HIPAA into legislation has helped millions of Americans to secure and keep health insurance coverage. But because every citizen has different health care needs and employment statuses, it’s important to research your options for health insurance—and to educate yourself on how to obtain and keep insurance coverage that meets your needs.
