In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA). HIPAA, its regulations and subsequent legislation under the Health Information Technology for Economic and Clinical Health (HITECH) Act, created sweeping changes to group health plans, some of which are discussed in the following paragraphs.
HIPAA requires that plans must provide special enrollment periods for certain employees and dependents. A 30-day special enrollment period must be provided to employees and dependents who lost coverage from another plan because they ceased to be eligible for coverage under that plan or because Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage under that other plan ends. If a plan provides for dependent coverage, it must provide a 30-day special enrollment period for individuals who become dependent because of marriage, birth or adoption.
HIPAA prohibits plans from imposing eligibility and premium restrictions based on health-related factors such as health status, medical conditions, claims history, receipt of healthcare, evidence of insurability or disability. A plan also may establish limited rebates and premium discounts in return for adhering to programs of health promotion and disease prevention, which qualify as “wellness programs.” If wellness rewards or penalties...
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