What Are Employer Obligations When Offering Health Insurance?

admin — Wed, 28 Oct 2009 23:21:40 +0000

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is perhaps best known for its privacy requirements. The advent of HIPAA meant patients now had to give written consent before their doctors could supply patient health information to health insurance companies. However, while patient privacy is one important aspect of HIPAA, the law actually provides several key benefits to workers, of which employers must be aware. Prior to HIPAA, employees feared leaving their employers and seeking new jobs because they might lose certain benefits. HIPPA provides new protections for workers.

PRE-EXISTING CONDITIONS

The length of time over which a pre-existing condition can be excluded and the length of patient history that may be reviewed for pre-existing conditions are limited. Pregnancy and genetic information may not be excluded. In addition, credit must be given for continuous previous health coverage.

ENROLLMENT RIGHTS

Employees may not be denied enrollment in the case of a life change, such as marriage, birth of a child, or adoption of a child.

DISCRIMINATION PROHIBITION

Employees may not be denied coverage, denied specific benefits, nor charged premiums based on health factors.

GUARANTEED HEALTH INSURANCE AVAILABILITY

Individual medical insurance is guaranteed for persons who lose employer-provided health insurance coverage or are otherwise ineligible for group coverage.

PRIVACY

As stated previously, individuals must give written consent before health information may be disclosed. Employers may not seek health information, nor share health information of which they have been made aware.

STATE GOVERNANCE

Oversight of HIPAA has been granted to state governments, and thus, states are granted the right to both administer HIPAA and regulate health insurance. Therefore, employers should check state laws in addition to the federal HIPAA law to ensure compliance.

SUMMARY

HIPAA put protections in place to ensure adequate health coverage for workers. However, note that the law does not require employers to provide health insurance, to offer specific benefits or cover specific conditions, or to cover pre-existing conditions. The law regulates benefits that employers offer and places limits on exclusions.

Health Insurance Q n A » hipaa privacy