Health Insurance Portability Accountability Act (HIPAA)

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These executive summaries were compiled from EMPLOYEE BENEFITS INFOSOURCE database, a source for information on employee benefits and human resources.

Preparing for a Data Disaster.
Ames, Anton; Scaff, Ben; Benefits & Compensation Digest; v45 no11 pp 40-43, 45 Nov 2008; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Natural disasters, terrorism, computer hackers and viruses -- threats abound for today’s benefits professional entrusted with protecting private health information and ensuring continuous plan operations. This article offers guidance for risk avoidance and disaster recovery for both large and small employers.
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Employee Benefits: Genetic and Disability Discrimination Laws Play Role in Wellness Plans, Attorney Says.
Meyer, Jo-el J.; Daily Labor Report; no194 p C1 Oct 7, 2008; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : At an American Law Institute-American Bar Association conference, attorney Greta Cowart explained how the Health Insurance Portability and Accountability Act (HIPAA), Americans with Disabilities Act (ADA), Title VII of the 1964 Civil Rights Act, the Genetic Information Nondiscrimination Act and tax regulations affect wellness initiatives. Subsidized gym memberships and onsite fitness centers avoid HIPAA issues but the individual value may be taxable. Onsite centers must be ADA accessible. Health risk assessments face multiple regulatory compliance challenges related to privacy, cash incentives and premium discounts. They must provide for alternative participation paths to achieve any cash reward.
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HIPAA Compliance: It's for Real.
LeTourneau, Janet; Broker World; v28 no9 pp 76, 78, 80, 82 Sep 2008; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The Health Insurance Portability and Accountability Act (HIPAA) has direct bearing on health flexible spending accounts (FSAs), though there are exceptions. All health and welfare plans must follow HIPAA certification requirements, except for governmental plans, group plans with only one current employee or those that qualify as an excepted benefit. There are also exceptions to HIPAA's administrative simplification rule which addresses several features, including electronic transmission of patient information. Self administered plans with under 50 members escape the rules for electronic transmission, privacy compliance and security compliance.
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Wellness Programs: What's Permitted?
Moran, Anne E.; Employee Relations Law Journal; v34 no2 pp 111-116 Autumn 2008; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The DOL has issued guidelines defining how employee wellness programs can use incentives but still avoid discrimination. Discrimination is based on health factors. Requiring a participant with known risk factors to take steps to reduce those risks to receive benefits would be discrimination. Programs that make incentives or rewards available to all regardless of health factors are not subject to Health Insurance Portability and Accountability Act (HIPAA) regulations. Examples include diagnostic testing where the reward is for participation instead of outcome, encouraging preventive care by paying care fees and programs that pay for smoking cessation classes even if the participant does not stop smoking.
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Wellness Program Incentives Must Comply With Federal Rules.
McCarthy, Colleen; Business Insurance; v42 no16 pp 17-18 April 21, 2008; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Most wellness incentives use positive reinforcement, but six percent of employers penalize employees who manage their health poorly. The Tribune Co. added a $100 monthly smoking surcharge to the premiums of employees who smoke, while Scotts Miracle-Gro Co. added $40 a month for those refusing to take a health risk appraisal at enrollment. The Health Insurance Portability and Accountability Act (HIPAA) says that if a health factor makes it inadvisable to reach a wellness program goal, employers must offer a reasonable alternative or waive the goal and still provide the reward. Sometimes complying with HIPAA is not enough, as state and local statutes may also impose additional regulations.
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Ask the Auditor: How to Prevent Privacy Breaches.
Denyer, Charles; Employee Benefit News; v22 no5 pp 17-18 Apr 15, 2008; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : With the growing maze of regulations concerning employee privacy, companies must have policies and procedures in place to protect confidential data. Internal control mechanisms should be established with federal laws such as the Health Insurance Portability and Accountability Act in mind. Documented procedures and nondisclosure agreements should address data theft, security, access and use. Companies should conduct background checks of job applicants, and new employees must be fully oriented on privacy issues. There should be a systematic process to end all access to internal information when an employee leaves. Tip lines can be valuable for gathering information on suspicious behavior anonymously.
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Health Incentives: The Science and Art of Motivating Healthy Behaviors.
Hall, Barry; Benefits Quarterly; v24 no2 pp 12-22 2nd Qtr 2008; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : According to a Buck Consultants employer survey, the use of incentive rewards for healthy behaviors is expected to double between 2008 and 2011. Well designed incentives can motivate dramatic change in a significant portion of the population. Incentives can be flexible, simple, and cumulative. Improperly designed, they can encourage dishonest reporting or unhealthy behaviors, or they may only encourage healthy behaviors for as long as the reward lasts.
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How Compliant Is Your Wellness Program?
Killian, Marie; Employee Benefit Plan Review; v62 no10 pp 19-21 Apr 2008; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The most effective wellness program can be a liability if it does not comply with provisions of the Americans with Disabilities Act (ADA), the Health Insurance Portability and Accountability Act (HIPAA) and a growing number of state regulations. HIPAA limits rewards for program participation, requires full access and mandates reasonable alternatives, among other requirements, but offers a few exceptions to its rules. The ADA requires reasonable accommodations for disabled employees and prohibits any negative action tied to a disability. Massachusetts is likely to join Michigan, the District of Columbia and some California cities having laws establishing height and weight as potential sources of discrimination.
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Employees Returning From Military Leave: Newest Potential Legal Liability for Employers.
Van Bogaert, Dan; Employee Relations Law Journal; v33 no4 pp 61-69 Spring 2008; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Some employees returning from military leave may have post traumatic stress disorder or other mental disabilities that entail extra considerations in their return to work. Provisions of the Uniform Services Employment and Reemployment Rights Act (USERRA), Servicemembers Civil Relief Act, Americans with Disabilities Act, Family and Medical Leave Act and Health Insurance Portability and Accountability Act pertain, as do tort law developments. Employers must support the returning employee while considering the safety of other workers. An employee assistance program can be an important aid in the transition back to work. HR should be thoroughly versed in USERRA provisions and take a proactive role in managing service members' return to work.
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Legal Compliance for Wellness Programs.
Relland, Susan; Employee Benefit Plan Review; v62 no9 pp 5-8 Mar 2008; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Wellness programs must comply with the Health Insurance Portability and Accountability Act, the Internal Revenue Code and the Americans With Disabilities Act. A wellness program is not considered discriminatory if it offers an incentive based on participation instead of reaching a particular health target. Government rules usually allow programs that cover the cost of gym membership or participation in health screening, weight loss or smoking cessation programs. Employee tax issues can arise if an employer gives cash, gift cards, airline points, trips or entertainment tickets in exchange for participation. The Age Discrimination in Employment Act of 1967 disallows a program that expects someone over age 40 to meet a specified health goal that would be difficult to reach by someone in that age group.
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The Role of Wellness Programs in an Employer's Health Strategy and the Legal Issues to Consider.
Relland, Susan; Szoeke, Patricia; HR Advisor: Legal & Practical Guidance; v14 no2 pp 25-32 Mar-Apr 2008; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Employers are promoting good health and holding down insurance costs through wellness programs with a wide variety of features. They must, however, consider the requirements of the Health Insurance Portability and Accountability Act, the Internal Revenue Code and the Americans with Disabilities Act. Voluntary employee wellness programs can be designed that incur little legal risk, but many employers are starting to question whether mandatory wellness programs can be designed in similar fashion. Such mandatory programs would need to be carefully planned for both effectiveness and compliance with federal and state laws, avoiding discrimination in benefits or employee costs.
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Notice 2008-23: Supplemental Health Insurance Coverage as Excepted Benefits Under HIPAA and Related Legislation.
Internal Revenue Bulletin; no2008-7 pp 433-435 Feb 19, 2008; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : This notice provides a safe harbor for supplemental group health insurance to be considered excepted from some requirements of the Health Insurance Portability and Accountability Act (HIPAA) and other laws governing group health plans. Those requirements pertain to preexisting health conditions, certificates of creditable coverage, discrimination on the basis of health, mental health parity and hospital stay after childbirth. To qualify for safe harbor, they must be issued by a separate entity from that providing the primary coverage, must fill gaps in the primary plan, be of significantly less value and lower cost. Like Medigap plans, supplemental plans may not base any differences in eligibility, benefits or premiums on health conditions.
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Field Assistance Bulletin No. 2008-02: Wellness Program Analysis
Maguire, Daniel J.; 6 pp Feb 14, 2008; misc. publication

Availability : International Foundation of Employee Benefit Plans
Abstract : The DOL's regulations on nondiscrimination under the Health Insurance Portability and Accountability Act prohibit a health plan from charging an individual higher premiums because of health factors. Such factors include health status, medical condition, claims history, disability and evidence of insurability. Health plans may vary benefits and premiums if an individual has met wellness program standards based on paragraph (f) of 29 CFR 2590.702. The updated regulation applies to plan years starting July 1, 2007 or after and calendar year programs starting January 1, 2008. A checklist describes scenarios and details of health factors in wellness programs.
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Health IT Raises New Issues for HIPAA Compliance.
Bridgeford, Lydell C.; Employee Benefit News; v22 no2 pp 1, 65 Feb 2008; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The goal of electronic health records is to make medical information easily transferable and accessible, but a side effect is the growing list of entities that must comply with rules of the Health Insurance Portability and Accountability Act (HIPAA). This list may expand to include vendors of health record software, effectively serving as health care clearinghouses. Employers are responsible for maintaining the privacy of individual health data and ensuring all their vendors do so as well. With the anticipated expansion of electronic health records and reliance on information technology (IT), maintaining protection over personal data will be increasingly challenging.
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States' Rights: More States Enacting Cafeteria Plan Requirements.
Willis: Focus On Benefits; pp 4-5 Jan 2008; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Massachusetts' effort to require employers to offer cafeteria plans has not yet been challenged in court. Details vary, but Connecticut, Missouri and Rhode Island have passed laws mandating employers to establish Section 125 plans into which workers can make tax free contributions. Cafeteria plans can run into compliance troubles arising from ERISA preemption, COBRA and the Health Insurance Portability and Accountability Act. ERISA requires employers to avoid any appearance of endorsing a particular plan in order to maintain tax incentives associated with cafeteria plans. Whether or not the Massachusetts law survives, employers are likely to continue offering or moving toward Section 125 plans.
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Healthcare Fraud: Auditing and Detection Guide.
Busch, Rebecca S.; 286 pp 2008; book

Availability : International Foundation of Employee Benefit Plans
Abstract : Health care fraud, waste and abuse create enormous financial costs and also threaten the quality of health care. Provides tips to spot potential problems and reveals the steps to take when fraud is suspected. Clearly defines the stakeholders: the patient; the provider; the payer; the plan sponsor; the vendors and suppliers; the government; organized crime; and market players. Outlines fraud prevention, detection, and investigation methods.
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Wellness Incentives Hit HIPAA Roadblock.
Geisel, Jerry; Business Insurance; v41 no51 pp 1, 21 Dec 17, 2007; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Plans that offer incentive programs tied to high deductible health insurance plans may be in jeopardy given DOL guidance issued in late 2007. The Health Insurance Portability and Accountability Act (HIPAA) bans discrimination by health plans on the basis of participant health and limits rewards for wellness plan participation. But the nondiscrimination rules do not apply to policies that meet four standards, including one that bans different treatment based on an individual's health. Plans basing rewards on actions such as taking a health risk assessment, not on actual personal health factors, comply with HIPAA.
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Field Assistance Bulletin No. 2007-04.
3 pp Dec 7, 2007; misc. publication

Availability : International Foundation of Employee Benefit Plans
Abstract : The Employee Benefits Security Administration has issued a field assistance bulletin on supplemental health insurance coverage relative to the Health Insurance Portability and Accountability Act (HIPAA) and other laws. The reforms under these laws do not apply to excepted benefits, and coverage through plans offering excepted benefits may not qualify as creditable coverage. Medicare and TRICARE are examples of plans providing supplemental excepted benefits. This bulletin provides employers safe harbor regarding ERISA health reform provisions if they offer independent primary coverage, their supplemental policy covers only gaps in primary coverage, the supplemental policy cost is not more than 15 percent of the primary policy cost and it is similar to Medicare in coverage.
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Financial Incentives Boost Wellness Program Participation.
Wojcik, Joanne; Business Insurance; v41 no49 pp 28-29 Dec 3, 2007; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Employers are offering incentives for employees to participate in wellness programs, satisfied they comply with nondiscrimination rules imposed by the Health Insurance Portability and Accountability Act (HIPAA) and other state and federal laws. Four in ten companies surveyed cut employee insurance premiums and 29 percent offer cash. Scotts Miracle-Gro found imposing higher premium payments was more effective to boost participation. The strategy is legal under HIPAA, though its status under the Equal Employment Opportunity Commission and the Americans with Disabilities Act is ambiguous. The uncertainty has prompted other companies to delay or retract penalties for nonparticipation.
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Privacy Issues Loom for Disability Benefits.
Ceniceros, Roberto; Business Insurance; v41 no46 pp 11-12 Nov 12, 2007; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : While the Health Insurance Portability and Accountability Act (HIPAA) protects individual medical record privacy, workers compensation and disability claim data are outside its scope. States laws and regulations by various state agencies come into play, creating a compliance maze. With the trend toward integrated disease and disability programs, there is greater risk of unintentional data sharing with an expanding group of service providers unaware of nonstandardized state regulations. HIPAA compliance does not ensure compliance with state privacy laws. As a result, employer liability increases.
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HIPAA Final Regs: What Employers Should Know.
Managing Benefits Plans; no07-10 pp 1, 13-15 Oct 2007; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Final regulations governing nondiscrimination provisions for health care benefits under the Health Insurance Portability and Accountability act of 1996 (HIPAA) went into effect July 1, 2007. The final rules provide guidance on the design and implementation of wellness programs. Under HIPAA's nondiscrimination requirement, employers are forbidden to use health status as a factor in determining eligibility or contribution levels. The regulations also provide a definition of wellness programs and outline design features that meet the nondiscrimination requirement.
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Retirement and Health Care Coverage: Questions and Answers for Dislocated Workers.
38 pp Sep 2007; misc. publication

Availability : International Foundation of Employee Benefit Plans
Abstract : Employees who lose their jobs may have rights to certain retirement protections. The Employee Retirement Income Security Act of 1974 offers rights and protections to private sector health and retirement plan participants. The Health Insurance Portability and Accountability Act of 1996 protects those needing to maintain health coverage between jobs or whose preexisting conditions may make it difficult to acquire health coverage at a new job. The Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA) gives workers the right to continue their health coverage for a time after losing their jobs. Employees should check plan documents and retained personal records to determine their rights and coverage.
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Firm to Charge Employees for Unhealthy Ways.
Wojcik, Joanne; Workforce Management; v86 no13 p 6 Jul 23, 2007; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Clarian Health tried to promote wellness through encouragement for five years but did not see sufficient results. After checking for compliance with the Health Insurance Portability and Accountability Act, the company decided to take a more punitive approach, penalizing unhealthy behaviors $5 each per paycheck to a maximum of $25 starting in 2009. Clarian is focusing on active monitoring of body mass index, cholesterol, blood glucose, blood pressure and tobacco use. Growing support by top executives for charging employees who continue unhealthy behaviors more for health insurance, 48 percent in 2005 up to 62 percent in 2007, indicates the strategy may catch on.
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Incentive-Based Plan Raises Questions.
Wojcik, Joanne; Business Insurance; v41 no29 pp 1, 54 Jul 16, 2007; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : The Vital Measures program, a product of UnitedHealth Group and BeniComp Group, supports wellness but may run afoul of the Health Insurance Portability and Accountability Act (HIPAA). HIPAA limits rewards in wellness programs to 20 percent of employee costs. Vital Measures provides credits that can total $2,000 for an individual to offset the employee's $2,500 deductible, far exceeding the 20 percent cap for the average health benefit cost. UnitedHealth responds that members can earn credits for positive health behaviors to counteract penalties for smoking, hypertension, high cholesterol and high body mass index. Another question is whether the program is exempt from HIPAA since it is viewed as providing supplemental health benefits.
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Employer to Fine Unhealthy Workers.
Wojcik, Joanne; Business Insurance; v41 no28 pp 1, 22 Jul 9, 2007; journal article

Availability : International Foundation of Employee Benefit Plans
Abstract : Clarian Health will start implementing a punitive approach to health management in 2009, authorized by provisions of the Health Insurance Portability and Accountability Act (HIPAA) effective July 1, 2007. Clarian will charge $5 per month for each of five possible infractions not under medical surveillance: tobacco use, obesity, high cholesterol, hypertension and high blood glucose levels. Exemptions will be permitted with a doctor's note. Clarian tried wellness initiatives relying on encouragement for five years but saw health benefit costs continue to rise 15.7 percent in 2007.
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