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 group health plans to provide portability of coverage by limiting exclusions based upon preexisting conditions
prohibits such plans from denying coverage to individuals or charging higher premiums based on health status
guarantees renewability of coverage to certain individuals.
However, Health Care Reform made sweeping changes to HIPAA’s restrictions on preexisting condition exclusions (PCEs). These changes prohibit group health plans from imposing any preexisting condition exclusions for group coverage, effective for plan years beginning on or after January 1, 2014. Thus, this manual no longer addresses the HIPAA “portability” mandates but it does address health status and guaranteed renewability coverage.
Basic terms
Group health plan - A group health plan is a plan (including a self-insured plan) of or contributed to by, an employer or employee organization to provide medical care (directly or through insurance, reimbursement or otherwise) to employees, their families, the employer or others associated with...
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