HHS releases final rule on access to group health coverage
HIPAA Weekly Advisor, January 3, 2005
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HHS issued Wednesday a final regulation on access to group health coverage, setting limits on the use of preexisting-condition exclusions and requiring these plans to offer "special enrollment" to individuals who lose eligibility for other coverage, according to an HHS press release.
The final regulation aims to bolster consumer protection under HIPAA while minimizing the burden placed on group health plans and group health insurers. The final rule
- requires these groups to provide, along with the certificate of credible coverage, an educational statement on HIPAA rights to individuals who lose coverage
- provides model language for the educational statement
- recognizes foreign-run and U.S. government-run health plans as creditable coverage that can be used to eliminate a preexisting-condition exclusion
- explains which plan benefit restrictions are preexisting-condition exclusions that must comply with HIPAA limitations
In addition, HHS published a proposed rule on other potential HIPAA group health plan requirements. For instance, HHS is asking for comments on a mathematical formula to count the average number of employees employed by a provider during one year.
The final and proposed regulations were published in the December 30, 2004 Federal Register. Go to the HHS Web site for more information.
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