HIPAA Information

Health Insurance Portability and Accountability Act (HIPAA)

The Health Insurance Portability and Accountability Act of 1996 (HIPAA (P.L. 104-191), was enacted on August 21, 1996. HIPAA amended the Employee Retirement Income Security Act (ERISA), the Internal Revenue Code (IRC), and the Public Health Service Act (PHSA).

HIPAA was enacted, among other things, to “improve portability and continuity of health care coverage in the group and individual markets,” as stated in the Congressional Conference Report. The law accomplishes these goals by instituting reforms in the group and individual insurance markets, including provisions limiting the use of preexisting condition exclusions, and requiring guaranteed access to health care coverage and guaranteed renewability for certain groups and individuals. There also are nondiscrimination provisions and special enrollment rights in the statute.

The HIPAA amendments are designed to improve the availability and portability of health coverage by:

1.	limiting exclusions for preexisting medical conditions; the County of Santa Barbara does not have any pre-existing condition limitations on enrollment in its health plans.
2.	providing credit for prior health coverage and a process for transmitting certificates and other information concerning prior coverage to a new group health plan or issuer; You have the right to receive a certificate of prior health coverage since July 1, 1996 to take to your new employer after you leave Santa Barbara County employment. Your health plan will issue a certificate after your separation. You may need to provide other documentation for earlier periods of health care coverage. Check with your new plan administrator to see if your new plan excludes coverage for preexisting conditions and if you need to provide a certificate or other documentation of your previous coverage.
3.	providing new rights that allow individuals to enroll for health coverage when they lose other health coverage or have a new dependent (special enrollment rights); Santa Barbara County recognizes these special enrollment rights which permit an employee (or a dependent of that employee) who is eligible for coverage, but not enrolled, to enroll in the plan at a date later than the initial enrollment period, if:
		the employee or dependent was covered under a group health plan or had health insurance coverage at the time coverage was previously offered to the employee or individual; 9 the employee stated in writing that the other coverage was the reason for declining enrollment (but only if the plan sponsor required such a statement and provided the employee with notice of the requirement and the consequences of the requirement at the time); 10 the other coverage was either COBRA coverage that was exhausted, or other health plan coverage that was terminated as a result of loss of eligibility for the coverage (including as a result of legal separation, divorce, death, termination of employment, or reduction in the number of hours of employment) or employer contributions towards the coverage were terminated; 11 and the employee requests enrollment not later than 30 days after the date of exhaustion or termination of the other coverage.
	The special enrollment periods supplement any regular open enrollment period otherwise available under the plan or policy. Also, an individual who enrolls for coverage during a special enrollment period is not treated as a “late enrollee,” even if the enrollment period corresponds with a regular open enrollment period.
4.	prohibiting discrimination in enrollment and premiums against employees and their dependents based on health status; Santa Barbara County enrollment requirements are only that an employee be in a regular County position and has no health requirements.
5.	preserving, through narrow preemption provisions, the states' traditional role in regulating health insurance, including state flexibility to provide greater protections.

Santa Barbara County complies with all additional State health insurance requirements.