The Health Insurance Portability and Accountability Act of 1996, or HIPAA as it is commonly known, is a bill that was passed by Congress to protect medical insurance for employees. This protection also extends to the employee’s family even if that employee should change jobs or is terminated from employment. HIPAA also ensures that an employee’s health coverage is transferable and can be continued regardless of employer.
The Health Insurance Portability and Accountability Act is broken down into two sections, Title I and Title II. Title I of HIPAA modifies both the Employee Retirement Income Security Act (ERISA) and the Public Health Service Act. In this way, it ensures that regulations are applied to group and individual health plans to those with insurance and those seeking it.
Title I also reduces periods of restrictions imposed by insurance companies on insurance applicants. For example, if someone goes for a period of time without insurance, experiences a break in coverage (minimum of 63 days), or has a pre-existing medical condition, the insurance company may accept the applicant but decline providing coverage for a period of time. The Health Insurance Portability and Accountability Act helps to reduce that restrictive period for applicants and amends health plans that would potentially decline someone with a pre-existing medical condition.
A pre-existing medical condition is any ailment or disability that presents at least six months prior to seeking health care benefits. The scope of Title I regulations does not apply to all health care plans. Supplemental health insurance plans such as Vision and Dental are exempt as they are not an integral part of the primary insurance policy; however, if they are included in the primary policy then HIPAA regulations do apply.
Title I under the Health Insurance Portability and Accountability Act also invalidates any hidden, or uniformed, exclusion periods in health insurance plans in order to protect beneficiaries.
Title II of outlines what constitutes health care fraud and the associated penalties. This is to protect medical information and create initiatives to prevent cases of health care fraud from happening. Along with the Department of Health and Human Services (HHS), HIPAA creates regulations and objectives to standardize health care and how medical information is to be saved and transmitted. The five main tenets of Title II are the Privacy rule, the Transactions and Code Sets rule, the Security rule, the Unique Identifiers rule, and the Enforcement rule. These rules have been established to safeguard medical information and how it is tracked.
The Privacy rule ensures that only certain medical information can be disclosed by specified persons.
The Transactions and Code Sets rule establishes numeric codes for electronic claims filed by the insurance company.
The Security rule establishes safeguards for personnel and electronic systems to coincide with HIPAA regulations.
The Unique Identifiers rule establishes specific acronyms and coded identifiers for insurance providers to determine health care providers and their plans.
The Enforcement rule establishes fines and penalties for those that violate HIPAA regulations in addition to creating guidelines for those investigating health care fraud.