The HIPAA or Health Insurance Portability and Accountability Act was passed by congress in 1996 in order to provide HIPAA rights or protection for employees when they change jobs or are involuntarily terminated from their job. The Health Insurance Portability Accountability Act was also designed to prevent health care fraud and to insure that the Department Health and Human Services establish rules that enhance health care system efficiency.
There are many facets to HIPAA and several moving parts to establishing HIPAA requirements. The most common Hippa rights subject matter is contained within Title One and Title Two of the HIPAA act.
Title One: Title one of HIPAA was enacted for the standardization of group health plans as well as certain individual health policies. Title one places regulations on restrictions that group plans can place on benefits for pre-existing conditions. The country would be a beautiful place if no one ever got sick. Unfortunately, we know that sickness is inevitable.
Group insurers are allowed to place 12-18 month "exclusions" of coverage on certain pre-existing conditions. Simply put a group insurer may offer group coverage for an individual. However, the insurer may delay coverage for a condition that existed prior to plan enrollment.
Title one of the Health Insurance Portability act protects the insurance seeker in that it does not allow insurers to place exclusions on pre-existing conditions if the insurance seeker had creditable coverage for a period prior to enrollment in the new plan. If there is an exclusion period, HIPAA decreases exclusion periods by the length of time that an insurance seeker had creditable coverage. For the sake of clarity of medical insurance portability an example is provided below:
John has recently been laid off from a job he has had for three years. John has had health insurance coverage through his employer's group health plan for the entire three-year period. John has been treated for a medical condition just 3 weeks prior to being terminated.
HIPAA requirements insure that if John is hired to a new job and subsequently applying for health coverage under a new group health plan, the insurer may not place an exclusion period of 12 months on John's pre-existing condition because he has had creditable group health plan coverage for at least a 12 month period prior to new plan enrollment.
Title Two: Title Two of HIPAA protects HIPAA rights by assigning penalties associated with offenses related to health care. HIPAA rights are further protected under Title Two with the creation of programs that target controlling fraud within the health care system. HIPAA requirements include rules to be drafted to increase the overall effectiveness of the health care system by creating criteria for the distribution of health care information.
The Department of Health and Human Services defines the entities that must comply with HIPAA requirements. Entities include health care providers, health plans and health care billing services that transmit medical information and health records.
The Department of Health and Human Services has disseminated five rules that are incorporated in Title Two of HIPAA. Privacy Rule, Transactions and Code Sets Rule, Security Rule, the Unique Rule and the Enforcement Rule. For more information regarding specific HIPAA rules see HIPAA rules at the Texas Low Cost Health Insurance web site.
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You might find yourself in a situation where you've got to purchase your own health insurance. HIPAA gives you a right to buy individual coverage despite your health, if you meet specific requirements: Your most recent insurance was under a group plan. You must have had at least eighteen months of continuous coverage without any 63 day breaks. Your coverage wasn't terminated for non payment or fraud. You aren't eligible for Medicare or Medicaid. You currently have no group health plan coverage available, and have exhausted COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage. HIPAA also enforces your rights of privacy when it comes to your own medical information, requiring your consent for the sharing of information between providers.
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