Private Health Insurance: Progress and Challenges in Implementing 1996 Federal Standards

Front Cover
William J. Scanlon
DIANE Publishing, 2000 - 52 pages
By setting minimum federal standards for certain aspects of private health insurance, the Health Insurance Portability & Accountability Act of 1996 (HIPAA) established new federal responsibilities. It instituted minimum standards of protection to improve access to health insurance for people obtaining coverage through employment as well as for those purchasing it as individuals. Reports on the implementation status of HIPAA provisions in the group insurance market; the price of coverage for certain individuals losing group coverage; the extent of consumer understanding of HIPAA as well as the law's protections; & federal efforts undertaken to ensure HIPAA compliance. Charts & tables.
 

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Page 30 - We also interviewed individuals at national organizations, including the National Association of Insurance Commissioners, the Health Insurance Association of America, the BlueCross BlueShield Association, and the Council for Affordable Health Insurance.
Page 34 - ... restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child, following a normal vaginal delivery, to less than 48 hours...
Page 32 - ... exceptions. Exceptions include cases of fraud, failure to pay premiums, enrollee movement out of a plan service area, the cessation of membership in an association's health plan, and the withdrawal of an issuer from the market. Limitations on Preexisting Condition Exclusion Period Group plan issuers may deny, exclude, or limit an enrollee's benefits arising from a preexisting condition for no more than 12 months following the effective date of coverage. A preexisting condition is defined as a...
Page 45 - Comments From the Health Care Financing Administration DEPARTMENT OF HEALTH & HUMAN SERVICES Health Care financing Administration The Administrator Washington, DC 20201 DATE: MAY 30 2000 TO: Leslie G.
Page 44 - CERTIFICATE OF GROUP HEALTH PLAN COVERAGE * IMPORTANT - This certificate provides evidence of your prior health coverage. You may need to furnish this certificate if you become eligible under a group health plan that excludes coverage for certain medical conditions that you have before you enroll. This certificate may need to be provided if medical advice, diagnosis, care, or treatment was recommended or received for the condition within the 6-month period prior to your enrollment in the new plan....
Page 44 - COVERAGE * IMPORTANT - This certificate provides evidence of your prior health coverage. You may need to furnish this certificate if you become eligible under a group health plan that excludes coverage for certain medical conditions that you have before you enroll. This certificate may need to be provided if medical advice, diagnosis, care, or treatment was recommended or received for the condition within the 6-month period prior to your enrollment in the new plan. If you become covered under another...
Page 32 - ... time against its preexisting condition exclusion period. The certificates must also document any period during which the enrollee applied for coverage but was waiting for coverage to take effect — the waiting period — and must include information on an enrollee's dependents covered under the plan. Guaranteed Access/Availability In the small group market, carriers must make all plans available and issue coverage to any small employer that applies, regardless of the group's claims history or...
Page 35 - January' 11,1 999, for a summary of resources spent by the Department of Labor's Pension and Welfare Benefits Administration (PWBA) on activities related to implementation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). In order to best respond to your request, we have enclosed charts organized by fiscal year that delineate FTE received as part of the agency's FY1998 and FY 1999 appropriation as well as the dollar amounts spent in FY 1 997, FY 1 998, and estimated to be...
Page 34 - ... reconstruction, the coverage will be provided in a manner determined in consultation with the attending physician and the patient for reconstruction of the breast on which the mastectomy was performed; surgery and reconstruction of the other breast to produce a symmetrical appearance: and prostheses and treatment of physical complications aft all stages of the mastectomy, including lymphedemas.
Page 35 - This structure applies to agency staff, whether they are responsible for preparing press releases or other public affairs materials, conducting investigations, or providing technical assistance to employers and participants and beneficiaries. It is our belief that this structure is the most efficient use of resources for the agency and best serves the needs of our customers. For example, we feel customer service staff must be able to respond to all benefit-related questions without having to refer...

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