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HIPAA Guidelines for Insurance

The Health Insurance Portability & Accountability Act of 1996 --- also known as HIPAA --- provides consumers, employers and healthcare-related providers with guidelines that address health insurance coverage and the handling of patient information. Under HIPAA, health insurance coverage becomes an individual right with certain protections under the law. These protections address privacy and security requirements regarding the handling of patient information and enact certain rights that determine a person's eligibility for continued health insurance coverage.

  1. HIPAA

    • Health insurance "portability" is one of HIPAA's main objectives. HIPAA guidelines provide certain protections that allow a person to remain eligible for health coverage when changing jobs, changing insurance plans or changing coverage types. As a federal law, HIPPA prevents employers from excluding employees with pre-existing conditions from access to group health insurance coverage. These rules apply for employee dependents included on an employee's health plan. Ensuring patient confidentiality is another primary objective enforced by HIPPA. These guidelines dictate how employers, healthcare providers and insurance companies handle and transmit patient information.

    Health Insurance Eligibility Guidelines

    • HIPAA guidelines make it easier for a person to qualify for health insurance coverage by addressing eligibility criteria for different circumstances. These criteria particularly address individual rights in cases where a person has a pre-existing condition. HIPAA guidelines define eligibility in terms of creditable coverage periods, meaning any time periods where a person carried health insurance coverage. As job changes typically involve a change in health insurance companies, under HIPAA, employees with pre-existing conditions cannot be excluded from an employer's health plan. On the other hand, insurance companies can impose exclusionary coverage periods, meaning no coverage for a pre-existing condition is provided for a predetermined period of time.

    Privacy Guidelines

    • HIPAA has specific guidelines pertaining to patient privacy and information disclosures. These provisions limit the release of patient information to minimum disclosure levels depending on the purpose of the transaction at hand. HIPAA guidelines provide boundaries for healthcare providers and insurance companies in terms of how medical records are used and transmitted. Organizations or agencies that violate HIPAA guidelines are held accountable by law and may incur criminal or civil penalties for violating patient rights. HIPAA privacy guidelines also enable consumers to access their medical records and monitor who has access to their medical information.

    Security Guidelines

    • Patient health information often contains bits and pieces of private, sensitive data as well as information regarding a person's physical status. HIPAA guidelines include a set of rules that specifically address security issues regarding patient information. As medical records are quickly moving from paper to electronic mediums, HIPAA security guidelines dictate system network protocols for healthcare organizations and insurance providers. These protocols require organizations to set usage guidelines in terms of who can access different pieces of information within a medical record. HIPAA security guidelines also require organizations to incorporate necessary safeguards, such as firewalls and antivirus programs, to prevent unauthorized access to patient records.

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