Health insurance portability and privacy — Pennsylvania

The Health Insurance Portability and Accountability Act (HIPAA) has a significant impact on medical coverage provided by employer-sponsored group health plans. Among other provisions, HIPAA:

• requires a group health plan to limit exclusions based upon pre-existing conditions

• prohibits such plans from denying coverage to individuals or charging higher premiums based on health status

• guarantees renewability of coverage to certain individuals

• requires a group health plan to provide for the privacy and security of plan participants’ private health information.

Employers who violate HIPAA’s portability, privacy or security provisions may face fines and/or lawsuits for failing to meet these requirements. Additionally, HIPAA imposes notification requirements should a plan sponsor become aware that certain health information has been improperly disclosed or accessed.

The original HIPAA Privacy and Security Rules focused on healthcare providers, health plans and other entities that process health insurance claims. Subsequent regulations expanded many of the requirements to business associates of these entities that receive protected health information, such as contractors and subcontractors. Potential penalties for noncompliance are based on the level of negligence with a maximum...

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