HIPAA (the Health Insurance Portability and Accountability Act of 1996) and Recent Changes
On August 21, 1996 a new law was signed called the Health Insurance Portability and Accounting Act of 1996, which is abbreviated as HIPPA (HEP-C, 2003 & Regence, 2003). The law guarantees many things to American workers, including continuous healthcare coverage for people who are changing jobs (DC, 2003). HIPPA also includes a provision that details the manner in which health information can be disbursed, and also seeks to "combat waste, fraud, and abuse in health insurance and health care (DC, 2003). Recently rules and regulations were developed by the government that mandate new requirements for creation, storing, transmittal and care of health related data manually and electronically (DC, 2003). Additionally, a Privacy Rule was enacted that regulates the manner in which private medical and health information can be shared or disseminated among health care entities and health plan providers, which includes employers (Regence, 2003).
The HIPPA law describes certain protections that are guaranteed to citizens of the United States who have pre-existing medical conditions (HEP-C, 2003). The act also protects individuals who might be "discriminated against" when seeking out health care coverage because of "previous health conditions or other factors that are directly related to a person's health or health history" (HEP-C, 2003).
There are certain provisions that already exist in federal law, one of which is ERISA, or the Employee Retirement Income Security Act of 1974 that require "employer-sponsored group health plans" such as the health insurance one can obtain at work, "individual insurance companies and Health Maintenance Organizations, or HMO's to follow certain rules when guaranteeing coverage" (HEP-C, 2003 & Regents, 2003).
HIPAA DEFINED
The Health Insurance Portability and Accountability Act basically add to many of the laws that are applicable to heath insurance. Particularly, HIPPA requires in part that health insurance companies, HMO's and employer sponsored insurance programs must not exclude candidates or employees seeking health insurance solely based on the fact that they have pre-existing health conditions (HEP-C, 2003). This means that if an employee who in the past had a serious health condition such as cancer applies for insurance, they can't necessarily be denied insurance coverage based solely on this fact alone. There may be certain limitations that a health insurance provider or employer can enact based on this information, depending on if they have an exclusion clause. Most clauses however, are limiting. Such situations will be described in greater detail below.
HIPPA is a protection mechanism; it protects employees and other workers from being discriminated against based on their prior health status, though it does not prohibit insurance companies from gathering information necessarily about this health statues. HIPPA also guarantees American workers that they will be allowed to renew their health insurance coverage with other employers if certain procedures are followed (HEP-C, 2003).
One additional benefit of HIPPA is that it protects workers from losing their health coverage by switching jobs or positions or similar circumstances (HEP-C, 2003). There are provisions however, in the new HIPAA law that allows employers who provide health plans and health insurers to include certain limitations or exclusions on conditions if certain requirements are met. These ideas are discussed further below.
PRE-EXISTING CONDITIONS
HIPPA requires that "exclusions or limitations for eligibility based on pre-existing conditions" are limited (HEP-C, 2003). This means in most circumstances, an individual can seek health coverage even though they have a serious health illness prior to applying for health insurance. There are some limitations on this clause however. A health insurer or group health plan may exclude individuals from coverage under the following conditions:
If an individual has a pre-existing condition, the exclusion must be related to the specific 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" (HEP-C, 2003). This means that if a person sought treatment for a pre-existing condition within six months of applying for health insurance, then they may in fact be excluded from coverage for care related to this treatment. If however they have not received any care than they will not be excluded against.
The health insurance carrier or group health insurance may exclude a candidate based on a pre-existing condition, under the above circumstance, however this exclusion "may not last for more than 12 months after an individual's enrollment date" (HEP-C, 2003). This means that if an individual is suffering from a pre-existing condition, the insurance provider is still obligated to cover the individual after...
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