The U.S. Departments of Labor, Health and Human Services and Treasury issued final rules implementing HIPAA’s primary portability provisions on December 30, 2004.
The new regulations, which essentially are similar to those issued in 1997, require group health plans and their insurers to set limits on the pre-existing condition exclusions that can be imposed on workers who lose their jobs or change jobs. The final rules require an “educational statement” about a beneficiaries’ HIPAA rights to be included in the certificate of creditable coverage, require written procedures for obtaining a certificate of creditable coverage, and recognize health plans maintained by foreign governments as creditable coverage.
Among other changes, are revisions in the special enrollment rules, which give some plan participants a right to special enrollment in certain circumstances and a change to the definition of “preexisting condition exclusion”. The final regulations will become effective for plan years starting on or after July 1, 2005.
In addition to the final rules, the Departments have jointly proposed portability rules that would provide individuals with more time to exercise HIPAA rights if they were not promptly notified they have lost coverage. Also proposed, are rules that would protect the HIPAA rights of employees who take leave under the Family and Medical Leave Act. The agencies are seeking comments on these proposed regulations. They have also issued a request for information on benefit-specific waiting periods. Comments must be submitted to the agencies by March 30, 2005.
The final regulations, the proposed regulations, and the request for information may be found here.