Compliance assistance for group health plans: HIPAA and other health care laws
U.S. Dept. of Labor, Employee Benefits Security Administration, 2004 - Business & Economics - 12 pages
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12-month pre-existing condition 48 hours 96 hours annual dollar limit annual or lifetime authorization requirement benefits for mastectomies cesarean section comply with HIPAA’s condition exclusion period connection with childbirth constructive dollar limit coverage cease date of coverage employees and dependents employer contributions enroll through special enrolled for coverage enrollment and annually Ensure evidence of insurability Example group health plan health insurance coverage HIPAA hospital length hospital stays hours or 96 including lymphedemas individual’s enrollment date late enrollees length of stay lifetime dollar limits limit on mental limitations on pre-existing loss of eligibility medical necessity medical-surgical benefits mental health benefits mother or newborn notice of pre-existing otherwise eligible placement for adoption plan is required plan must provide plan or health plan or issuer plan provides benefits pre-existing condition exclusion Prostheses reﬂected special enrollment notice special enrollment provisions stages of reconstruction stay in connection termination of employment utilization review waiting period WHCRA