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HIPAA Notice Requirements

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) provides rights and protections for participants and beneficiaries in group health plans and for those who purchase individual health insurance plans. The U.S. Department of Labor enforces HIPAA. HIPAA has various notice requirements as part of its regulatory scheme. The Department of Labor publishes a Compliance Assistance Guide that organizes the notice requirements in HIPAA into a chart, applicable as of October 2010.

  1. HIPAA Certificate of Creditable Coverage

    • The HIPAA certificate of creditable coverage notice is generally given when there is a loss of coverage. The notice requirement includes a list of items, which include the plan administrator's name, address and phone number; the individual's creditable coverage information; and an educational statement regarding HIPAA, which explains such things as the preexisting condition exclusion rules and the prohibitions against discrimination based on any health factor.

    General Notice of Preexisting Condition Exclusion

    • The general notice of preexisting condition exclusion is generally given with any written materials provided for enrollment. This is notice of the existence and terms of any preexisting condition exclusion under the plan, including the length of the plan's look-back period, the maximum preexisting condition exclusion period under the plan and how the plan will reduce the maximum preexisting condition exclusion period by creditable coverage, among other provisions.

    Individual Notice of Preexisting Condition Exclusion

    • This notice is provided as soon as possible after termination of creditable coverage and states the plan's or issuer's determination of any preexisting condition exclusion period that applies to the individual, including the last day on which the exclusion applies and the basis for the determination.

    Notice of Special Enrollment Rights and Wellness Program Disclosure

    • The notice describing special enrollment rights is required at or before the time an employee is given the opportunity to enroll in a health care plan. The wellness program disclosure is required in all written materials that relate to these programs. This notice states those who find it unreasonably difficult due to a medical condition to comply with the wellness rewards program can contact the provider to qualify in a different way.

    Hospital Stays in Connection with Childbirth

    • The description of rights with respect to hospital stays in connection with childbirth must be provided in the summary plan description. It must include a statement describing any requirements under federal or state law applicable to the plan, among other provisions.

    WHCRA Enrollment and Annual Notices

    • Women's Health and Cancer Rights Act (WHCRA) notices are provided upon enrollment and annually, and include special statements for participants and beneficiaries who are receiving mastectomy-related benefits.

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