Federal Rules of the HIPAA Procedure

The United States government enacted the Health Insurance Portability and Accountability Act (HIPAA) in 1996. This act established federal standards to reduce health insurance abuse for pre-existing medical conditions and helped ensure access to and continuation of health insurance. HIPAA was also created to prevent health insurance discrimination against workers and their families.

Pre-existing Conditions and Discrimination

• HIPAA regulations protect workers and their families from being denied health insurance by limiting exclusions for insurance due to pre-existing medical conditions. Health insurer certificates that document prior health coverage for a pre-existing condition are used as credit towards the maximum exclusion period to reduce the waiting time for coverage under a new health insurer. Lack of insurance coverage, excess premium charges and denial of benefits that are the result of discrimination based on health status are HIPAA violations.

HIPAA Privacy Rules

• In 2003, HIPAA was amended to include Privacy Rules (Standards for Privacy of Individually Identifiable Health Information), also known as Privacy Health Information (PHI). PHI created the first national privacy standards for sharing patient health information. The Privacy Rule regulates private, secure disclosure and maintenance of health information in electronic, oral and written format. Some examples of covered health records are enrollment, claims and payments, as well as the sharing of medical information among health plans.

Medical Entities Covered

• The Privacy Rule applies to doctors, nurses, pharmacies, health insurance companies, HMOs, other health care providers and government programs such as Medicaid and Medicare. Law enforcement agencies, life insurance companies, school districts and state child protective services are some of the entities that are exempt from the Privacy Rule.

Sharing Health Information

• HIPAA permits the sharing of patient information for optimal medical care or for the public's protection from transmittable illnesses. Health providers must provide each patient with a free yearly report that has the recipient's name, the date and the reason for the distribution if the patient's information is shared. A patient has the right to give permission for information sharing and may also ask the doctor not to share medical records in certain circumstances. HIPAA honors a patient's request for a reasonable contact method such as telephone notification at the office rather than at home or by mail.

Additional HIPAA Rights

• A patient has the right to see his health records, get a copy of them and request the correction of medical information even if medical personnel are in disagreement. A patient also has the right to file a complaint with the health provider, health insurance company and the United States government when his privacy rights are violated.

Filing a Complaint

• Anyone can file a complaint for HIPAA Privacy Rule violations for herself or for someone else. Complaints should include all of the violation details and be emailed, faxed or sent by mail to the Office of Civil Rights regional manager (U.S. Department of Health and Human Services) within six months. The Office of Civil Rights recommends that you should use its complaint form, which can be found on-line at the U.S. Department of Health and Human Services, Office of Civil Rights section.