Learn More about HIPAA Regulations

The Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996 as an amendment to the Employee Retirement Income Security Act (ERISA). 

HIPAA's goal is to limit new employers from excluding coverage for preexisting conditions, providing new rights to individuals who lose their coverage to enroll in a group health plan, and banning discrimination against employees and their dependent family members based on any preexisting conditions.

HIPAA also protects patients’ paper and electronically stored medical information through the Privacy Rule and the Security Rule, both of which were implemented by the U.S. Department of Health and Human Services.

HIPAA Regulations and Preexisting Conditions

Before HIPAA, many employers’ group health plans denied new employees coverage of preexisting conditions that endured at the time of enrollment. Now under HIPAA, the preexisting condition exclusion can only be applied if the employee received any medical advice, diagnosis, treatment or care pertaining to the condition during the 6 months prior to enrollment. If your preexisting condition is excluded from the plan, this exclusion period cannot exceed 12 months for most people. This 12 month exclusion period may be reduced by receiving "creditable coverage" for the time coverage was held prior to new employment. 

Employees can now rest easy thanks to the new HIPAA regulations and no longer worry about losing coverage on preexisting conditions when switching jobs. 

New HIPAA Enrollment Rights

Some individuals lose health coverage based on certain situations. Those of them who previously held coverage now have an opportunity to enroll outside of the enrollment period if they lost coverage based on any of these situations:

  • Spouse’s employment ending

  • Spouse’s death

  • Divorce or separation

  • Reduction in work hours

HIPAA Discrimination Protections

HIPAA regulations ban individuals from being excluded from coverage or denied benefits based on health-status related factors. Therefore, a health plan cannot deny an employee medical coverage based on a claims experience, his or her medical history, genetic information, or disability.

It is important to remember that although HIPAA provides a wide array of new rights, it does not require that employers provide health coverage. HIPAA is only a set of guidelines for employers who do choose provide health coverage.

If you have any questions regarding HIPAA regulations and how they might affect you and your business, feel free to connect with a business attorney on UpCounsel by asking a question or posting a job request if you have questions about any regulations regarding HIPAA law.