Health Insurance Portability and Accountability Act of 1996 (HIPAA)
HIPAA, Title I through Title V
The Health Insurance Portability and Accountability Act (HIPAA), enacted in August of 1996, amends the Employee Retirement Income Security Act of 1974, the Internal Revenue Code of 1986, and the Public Health Service Act. HIPAA was passed by Congress to reform the insurance market and simplify health care administrative processes. It’s purpose is to improve the portability and continuity of health insurance coverage for individuals and groups, to combat fraud and abuse in the health care industry, to promote the use of medical savings accounts, to improve access to long-term care, and to enhance health care insurance and delivery systems by making them more efficient, simpler, and less costly. HIPAA is the single most significant federal legislation affecting the health care industry since the creation of the Medicare and Medicaid programs in 1965. HIPAA consists of the five titles listed below.
Title I: Health Care Access, Portability, and Renewability
Title I includes provisions for certificates of coverage and portability of health insurance.
Title I prohibits discrimination in enrollments and in premiums charged to employees and their dependents based on health status related factors. Its provisions primarily affect employers and health insurers and are currently in effect.
Title II: Preventing Fraud and Abuse; Administrative Simplification
• Fraud and Abuse: Establishes several health care fraud and abuse programs and revises sanctions for pre-existing fraud and abuse laws.
• Administrative Simplification: Requires that specified covered entities use designated standard transaction formats and code sets for the electronic transmission of health information. In addition, Title II establishes standards for the privacy and security of individually identifiable health information, and provides penalties for its wrongful disclosure.
Title III: Tax-Related Health Provisions
Title III provides for certain deductions for medical insurance, and makes other changes to health insurance law.
Title IV: Application and Enforcement of Group Health Plan Requirements
Title IV specifies conditions for group health plans regarding coverage of persons with preexisting conditions, and modifies continuation of coverage requirements.
Title V: Revenue Offsets
Title V includes provisions related to company-owned life insurance, treatment of individuals who lose U.S. citizenship for income tax purposes and repeals the financial institution rule to interest allocation rules.
Disclaimer: EDH obtains its information from sources it believes to be reliable. However, due to human and mechanical errors as well as other factors, EDH makes no representations or other warranties, express or implied, to the accuracy of the information. This information is provided for discussion purposes only. It does not constitute legal advice and is not intended for use without advice of legal counsel. It is also not a substitute for legal or other professional advice. Users should consult their own legal counsel for advice regarding the application of the law and this document as it applies to the HIPAA regulations.
