The U.S. Department of Labor published new regulations earlier in the year (2001) related to HIPAA (Health Insurance Protability and Accountability Act) nondiscrimination provisions. These provisions become effective on the first day of the first plan year after July 1, 2001. It is currently under review by the Bush administration, so changes to the regulations are possible.
The new rules generally prohibit group health plans and group health insurance issuers from discriminating against individual participants or beneficiaries based on any “health factor” of such participants or beneficiaries.
The eight health factors are:
Health status,
Medical condition (including both physical and mental illnesses),
Claims experience,
Receipt of health care,
Medical history,
Genetic information,
Evidence of insurability,
Disability
The inclusion of evidence of insurability in the definition of health status is intended to ensure, among other things, that individuals are not excluded from health care coverage due to their participation in activities such as motorcycling, snowmobiling, all-terrain vehicle riding, horseback riding, skiing and other similar activities.
The interim regulations permit plans and issuers to treat late enrollees differently from similarly situated individuals who enroll when first eligible.
In addition, the interim regulations:
Explain the application of these provisions to benefits;
Clarify the relationship between the HIPAA nondiscrimination provisions and the HIPAA preexisting condition exclusion limitations;
Explain the application of these provisions to premiums;
Describe similarly situated individuals;
Explain the application of these provisions to actively-at-work and nonconfinement clauses;
Clarify that more favorable treatment of individuals with medical needs generally is permitted.
