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HIPAA

Individuals and Family PlansAll About Health InsuranceHIPAA

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Protecting your privacy, your information

HIPAA is a reform of the American healthcare system passed by Congress in 1996. HIPAA is administered by the US Department and Human Services Office for Civil Rights.

HIPAA is a federal law that protects your medical information whether written, electronic, or oral. You’ve most likely run into HIPAA when you sign a form at the doctor’s office. Health plans, doctors, hospitals, and other healthcare providers must adhere to the rules and requirements outlined by HIPAA.

Title I: Healthcare Access, Portability, and Renewability

Under Title I, a group health plan — like one offered by an employer — can’t deny you coverage or charge you a higher or lower premium based on your health status. Workers and families are allowed access to healthcare if they change jobs or lose their job.

HIPAA Eligibility

HIPAA guarantees eligible individuals healthcare coverage in all states. You are HIPAA eligible if you:

  • Had 18 months of group health coverage
  • Have used up COBRA coverage (if applicable)
  • Are not eligible for Medicare, Medicaid, or COBRA coverage
  • Are not otherwise insured
  • Apply for individual health insurance within 63 days of losing prior creditable coverage

Title II: Standards for Transactions 

Title II sets national standards for how electronic healthcare transactions are handled. These transactions include enrollment, health claims, eligibility determination, claim status verification, and payment of premiums.

Title II includes three rules:

  1. Security Rule puts in place security standards for your Electronic Protected Health Information (ePHI). Providers must follow security standards to protect created, received, updated, or sent ePHI.
  2. Privacy Rule protects access to your medical records and payments, if your health information is or isn’t used for purposes other than treatment or payment (like medical research).
  3. Enforcement Rule penalizes violations of these Administrative Simplification rules.

Title III: Tax-Related Health Provisions 

Title III allows for certain deductions for health insurance. It standardizes the amount you can save per person in a pre-tax medical savings account.

Title IV: Enforcement of Group Health Insurance Requirements 

Title IV provides explanations and broadened information on insurance reform provisions.

Title V: Revenue Offsets 

Title V regulates how employers can deduct company-owned life insurance premiums for income tax purposes.