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PORTABILITY OF COVERAGE

Last October and December, we provided you with information on the provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). On April 8, 1997, companion regulations were issued jointly by the Departments of the Treasury, Labor and Health and Human Services. These regulations address the access and portability sections of the law passed by Congress in 1996.

While many features of the law have been defined by federal regulation, its full effect on insured group health plans will not be known until the states have passed conforming legislation. Insured group health plans will received additional information as their respective states take the required legislative and regulatory actions.

The attached information summarizes the federal regulations as they relate to:

Provisions that apply to insured and self-insured group health plans.

Eligibility Rules

Limitations on Pre-Existing Condition Exclusions

Creditable Coverage

Special Enrollment Periods

Provisions that apply only to insured group health plans

Guaranteed Renewal of Group Insurance

Guaranteed Issue of Group Insurance

Disclosure of Information by Insurers

This does not contain information on group to individual plan portability regulations. Other topics in HIPAA were not addressed by these regulations including those on Fraud and Abuse, Administrative Simplification and Medical Savings Accounts (MSA’s).

Some Important Dates You Should Know

June 1, 1997

Group health plans and insurers must be issuing certificates of creditable coverage to members and dependents losing coverage.

July 1, 1997

ERISA provisions affecting both insured and self-insured group health plans take effect at the first plan anniversary on or after July 1, 1997. These provisions include the new eligibility rules, special enrollments, creditable coverage, and notifications described in these links.

Group health plans subject to ERISA with plan years beginning on or after this date must distribute a summary of material modification within 60 days after a material reduction in benefits is adopted.

June 30, 1998

Group health plans and insurers must hold data necessary to issue certificates of creditable coverage to individual dependents.

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