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Health insurance portability and privacy — Tennessee

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

  • requires a group health plan to limit exclusions based upon preexisting conditions
  • requires a group health plan to provide certificates of creditable coverage
  • prohibits such plans from denying coverage to individuals or charging higher premiums based on health status
  • guarantees availability and renewability of coverage to certain employers
  • 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 monetary penalties and/or lawsuits for failing to meet these requirements.

For purposes of HIPAA’s portability, access, and renewability requirements, health insurance coverage means benefits for medical care under any hospital or medical service policy or certificate, hospital or medical service plan contract, or HMO contract offered by a health insurance issuer. It does not, however, include certain “excepted benefits” such as:

  • accident-only coverage
  • disability income insurance