Background on the Health Insurance Portability and Accountability Act
The Health Insurance Portability and Accountability Act (HIPAA), provides protections for eligible workers and their families. Among its many attributes, HIPAA provides additional opportunities to enroll in a group health plan if an employee loses alternative coverage or experience certain life events. HIPAA also prohibits discrimination against employees and their dependents based upon any health factors he or she may have.
HIPAA protects workers and their families by providing additional opportunities to enroll in group health plan coverage when the employee loses health coverage, gets married or adds a new dependent, thereby helping to ensure continuous coverage for an eligible employee. HIPAA further prohibits discrimination in enrollment and in premiums charged to employees and their dependents based on any health factors, and preserves the States’ role in regulating health insurance, including the States’ authority to provide greater protections than those available under Federal law.
Inherent in the protections afforded by HIPAA, employees and their family members cannot be denied eligibility or benefits based upon certain, “health factors,” including prior medical conditions, previous claims experience, and genetic information. Eligible employees also cannot be charged more than similarly situated individuals based on any health factors. HIPAA and the Affordable Care Act (ACA), also provide protections from impermissible discrimination based upon a health factor in wellness programs related to group health plan coverage, (such as those that encourage employees to work out, stop smoking or meet certain health standards such as a target cholesterol level).
While currently in existence, the ACA prohibits health plans from imposing preexisting condition exclusions for plan years beginning on or after January 1, 2014. For prior years, HIPAA limited these exclusions and required plans to offset preexisting condition exclusion periods if the individual had prior health coverage.
As the landscape of healthcare in the United States is currently in flux, it is important for both employers and employees to understand the protections and responsibilities imposed upon both parties under HIPAA and the ACA and be ready to adapt as new and diverse ideas are interposed into the healthcare marketplace.
If you are an employer and are seeking compliance with the HIPAA coverage, contact the experienced employment law attorneys today at 203-221-3100, or by email at JMaya@mayalaw.com. We have the experience and knowledge you need at this critical juncture. We serve clients in both New York and Connecticut including New Canaan, Bridgeport, White Plains, and Darien.
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