Final HIPAA Portability Rules Issued
Nine years later, the regulations are clarified and changed
The Department of Labor (DOL), the Department of Health and Human Services (HHS)
and the U.S. Department of Treasury posted final HIPAA Portability Regulations on
December 30, 2004, which provides workers greater access to group health plan coverage.
Originally, the rules, which apply to group health plans and their insurers, were
issued on an interim basis in 1997. The final rules become effective February 28, 2005,
with an applicability date to apply for plan years starting on or after July 1, 2005.
The final regulations adopt the interim rules but also include several modifications:
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An educational statement is required as part of the Certificate of Creditable Coverage.
Model language is provided that could be used for this statement.
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The regulations recognize health plans maintained by foreign governments as creditable coverage.
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Sample language plans that issuers may use to satisfy obligations to provide participants notice
of preexisting condition exclusions is included.
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The rules clarify that certain plan benefit restrictions are, in fact, preexisting condition
exclusions that must comply with HIPAA's limitations on such exclusions.
The proposed regulations would:
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Provide an extension of time for individuals to exercise certain HIPAA portability rights.
There are some situations in which the individual must exercise rights within a certain number
of days after losing coverage, but do not receive the Certificate of Creditable Coverage promptly.
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Specify that group health plans and group health insurance issuers must provide a Certificate
of Creditable Coverage when someone leaves a group health plan under Family and Medical Leave
Act (FMLA). That period of time during which the person does not have coverage, while on the
leave, does not count against the significant break in coverage for either the employee or dependents.
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Set forth a mathematical formula for counting the average number of employees working during
a year by an employer.
"In an era when American workers often change jobs, and even careers, several times in the course of
their lives, it is important that they are able to respond to the modern workplace without having to
fear for their health insurance," HHS Secretary Tommy Thompson stated.
HIPAA protects workers and their families by:
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Limiting exclusions for preexisting medical conditions.
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Providing credit against maximum preexisting condition exclusion period for prior
health coverage and a process for providing certificates showing periods of prior
coverage to a new group health plan or health insurance issuer.
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Providing new rights that allow individuals to enroll for health coverage when they lose other
health coverage, get married or add a new dependent.
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Prohibiting discrimination in enrollment and in premiums charged to employees and their
dependents based on health status-related factors.
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Guaranteeing availability of health insurance coverage for small employers and renewability
of health insurance coverage for both small and large employers.
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Preserving states' role in regulating health insurance, including states' authority to
provide greater protections than those available under federal law.
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Improving disclosure about group health plans.
Infinisource clients who add HIPAA Certificate Administration to their COBRA administration solution
quickly appreciate the result-effortless and cost-efficient compliance. HIPAA has forced employers,
carriers and health care professionals to add more administrative tasks to the workload. Make sure you
are providing HIPAA Certificates of Creditable Coverage properly and remove even more from your to-do
list with Infinisource HIPAA Certificate Administration.
For more information on adding this service please call 800-779-6384, email solutions@infinisource.net
or visit our website at www.benefitsolved.com.
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