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HIPPA, nondiscrimination requirements and health factors

| Sep 8, 2017 | Employee Benefits |

Union members in New York should know certain facts about the Health Insurance Portability and Accountability Act (HIPAA), how it works and when they are shielded from discrimination. Since health coverage has become such a hot topic and its status is growing more confusing, having coverage as part of an agreement for employee benefits is more important. Knowing facts about HIPAA is vital.

HIPAA does the following for group health plans: it provides people certain enrollment rights when they have special events such as the birth of a child; it prohibits discrimination in eligibility, benefits and premiums based on health factors; and it does not have preexisting condition exclusions for those who joined from January 1, 2014 forward. For those who signed up prior to that date, they no longer must issue a general notice of preexisting condition exclusion.

Nondiscrimination means that the person cannot be denied eligibility or ongoing eligibility to enroll in the plan because of health factors that might have otherwise done that. They cannot be charged a greater amount for coverage than an individual in a similar situation would be for any health factor. Relevant health factors include: the health status; a medical condition including mental and physical illness; past claims; receiving health care; the medical history; genetic history; evidence related to insurability; or disability. Evidence related to insurability includes activities that could be considered high risk like riding a motorcycle, riding horses and skiing, among others. It also includes problems that came about due to domestic abuse.

When considering the cost of healthcare and how the system is currently muddled based on political realities, there might be attempts on the part of employers to skirt the requirements for HIPAA. If there is a violation of labor law related to HIPPA, having help from an attorney is essential.

Source: dol.gov, “Health Coverage Portability (HIPAA) Compliance FAQs,” accessed on Sept. 5, 2017