About Your Rights Under HIPAA

The Health Insurance Portability and Accountability Act of 1996--or HIPAA, as it is most popularly known--was enacted by Congress in 1996.

Function

• Title I of HIPAA regulates group health and some individual health insurance policies as well as limitations that some insurance companies seek to impose due to pre-existing conditions. Title I also protects the insured from losing all coverage when they change or lose their jobs.
  Title II, also called the Privacy Rule, seeks to protect individuals' health information while permitting the exchange of the information to provide high-quality health care. Entities covered by this rule include health care providers, insurance (or health) plans and health care clearinghouses such as billing services.

Misconceptions

• Not all health care plans are governed by Title I of the HIPAA rule. Long-term health care plans and separate plans such as dental or vision coverage are exempt from HIPAA governance. Should these plans, at some point, be combined with the general health plan offered by a company, then HIPAA compliance is required. Unfortunately, if these limited-coverage plans do not become part of a larger health plan, and an individual loses her job, a certificate of continuous coverage needed by a new employer's insurance company may not be obtained.

Benefits

• The most important benefit of Title I of HIPAA is that it protects the insured's right to coverage for pre-existing conditions when there has been a break in coverage. Most group health plans seek to refuse provision of benefits for 12 months after enrolling in a plan; however, if an individual can prove continuous coverage before enrolling in the plan, the time period of exclusion may be reduced.
  Title II imposes civil and criminal penalties for fraud and abuse of an insured's protected health information. The most significant standard that Title II imposes, however, is geared toward standardizing the use and reporting of health care information to entities other than the individual. Title II also protects the insured's rights by requiring entities bound by the rule to notify the insured when his private health care information is disseminated.

Features

• Under Title II of HIPAA, information covered in this plan includes an individual's physical or mental health condition, details of health care services provided to said individual and payment details for such services. The greatest purpose of Title II of HIPAA is to limit circumstances under which an individual's health information can be used or disclosed. It can be disclosed if an individual gives her permission or as the rule permits.

Considerations

• In only two instances may an entity disclose health records or information: (1) to the individual or the individual's representative when that person requests disclosure and (2) to the Department of Health and Human Services when it is reviewing a possible violation or investigating or taking action against an entity.