Title I of HIPAA

Title I of the Health Insurance Portability and Accountability Act (HIPAA) is focused on Health Care Access, Portability, and Renewability. It primarily addresses the protection of health insurance coverage for individuals when they change or lose their jobs. 

What is Title I of the Health Insurance Portability and Accountability Act (HIPAA)?

Title I of the Health Insurance Portability and Accountability Act is about health insurance reform. It ensures the availability of health insurance coverage to all individuals, especially those who may have lost their jobs or lost coverage during the interim period of their job transition. The title regulates both group and individual health insurance availability and safeguards against denying coverage to individuals with specific illnesses or pre-existing conditions. Additionally, it prohibits placing lifetime limits on an individual's coverage.

Provisions of the title

• Portability: It allows individuals to retain their health insurance coverage when moving from one job to another or when changing health plans.
• Pre-existing conditions: It restricts health insurers from excluding coverage for pre-existing medical conditions, ensuring that individuals with prior health issues are not denied coverage or face higher premiums.
• Renewability: It mandates that health insurance policies are renewable and cannot be canceled for reasons unrelated to specific policy violations, such as the individual's health status.
• Special enrollment periods: Title I requires health insurance plans to allow individuals to enroll or switch plans during special enrollment periods triggered by certain life events (e.g., marriage, birth of a child, or job loss).

Related: Does HIPAA allow continuity of health insurance?

Regulation of health insurance availability and coverage

Title I of HIPAA regulates the availability of both group and individual health insurance policies. It modified several laws, including the Employee Retirement Income Security Act (ERISA), the Public Health Service Act, and the Internal Revenue Code. These laws ensure health insurance policies are more accessible and equitable for individuals undergoing transitions in employment or health coverage.

A feature of Title I is its requirements for group health plans concerning pre-existing conditions. “Group health coverage may only refuse benefits related to preexisting conditions for 12 months after enrollment or 18 months for late enrollment,” says a study published by Europe PMC. Furthermore, Title I enables individuals to shorten the exclusion period based on how long they were covered by a previous plan, addressing gaps in coverage.

Another significant provision is the concept of "creditable coverage," which applies to all group and individual health plans, including programs like Medicare and Medicaid. Under Title I, a "significant break" in coverage is defined as any 63 consecutive days without creditable coverage. This provision allows premiums to be tied to factors like body mass index (BMI) and tobacco use to encourage healthier lifestyle choices.

Additionally, Title I mandates insurers offer policies to individuals leaving group health plans with creditable coverage exceeding 18 months, and renew individual policies as long as the plan is available. If the insurer discontinues the plan, they must offer alternatives without exclusions, regardless of the individual's health status, as long as the insurer continues to operate in the market.

See also: HIPAA Compliant Email: The Definitive Guide

FAQs

What is HIPAA?

HIPAA is a U.S. federal law designed to protect sensitive patient health information, improve the efficiency of the healthcare system, and ensure privacy and security standards for health data. It includes provisions on health insurance portability, administrative simplification, and healthcare fraud enforcement.

Go deeper: What is HIPAA?

What are HIPAA Titles?

HIPAA Titles refer to the sections of the Health Insurance Portability and Accountability Act (HIPAA) that address different aspects of healthcare regulation, including the protection of patient information, insurance coverage, and administrative processes. Each title serves a distinct purpose.