HIPAA Law Explained - The Health Insurance Portability And Accountability Act

HIPAA Law Explained - The Health Insurance Portability And Accountability Act 

Health Insurance Portability and Accountability Act, or HIPAA is an amendment to Employee Retirement Income Security Act ERISA done in 1996. The new act came with the added protection of workers and their respective families. It limits the exclusion of coverage of preexisting conditions by new workers, bans discrimination against workers as well as their dependents based on their preexisting conditions and it also provides new rights to those who lose coverage so they can enroll in alternative health plan. Also under this act, patient information electronically stored is protected thanks to the HIPAA Privacy Rule. 

Act effects in preexisting conditions 

Before the act was put in place, group health plans would dent new employees preexisting condition coverage. This was for all conditions that were present by the time the employees were enrolled. However, under HIPPA Law, the exclusion only applies if there is a diagnosis, medical advice, care or treatment for the condition six months to employee enrollment. If all these were done in previous months, however, the health plan might impose the exclusion too. In most cases, the exclusion period does not exceed 12 months. Creditable coverage can prove to be of importance in reducing the 12-month exclusion for the health coverage. 


The improved act has basically eliminated employee worrying over losing coverage on the preexisting conditions, even when they are switching from one job to another. In essence, HIPAA protects individuals from being excluded from coverage and from being denied the benefits based on their health statuses. A health plan can therefore not deny an employee medical coverage due to the medical history, disability, claims experience or genetic information. The act by law has struck a balance for all employees to receive equal treatment upon enrollment. It offers equal employment opportunities to all regardless of their health situations prior to getting employed. 

Rights to special enrollment 

Losing coverage in some situations is at times inevitable. Luckily, the individuals who end up losing their held coverage still can enjoy the opportunity of enrolling outside enrollment period. The special enrollment can be made necessary by situations such as the death of a spouse, ending of spouse employment, separation or divorce and work hour reduction affecting health coverage.  In as much as HIPAA offers an array of new employee rights as far as health is concerned, it should be remembered that it does not compel employers to provide health coverage. It is basically a set of guidelines to be followed by employers in case they choose to offer health coverage for their employees. 


Health coverage is of great importance. It can come in handy when situations arise; taking off money worries from employees. However, in most cases, there are requirements for qualification for coverage by employer. It is helpful to keep up to date with HIPAA as an employer to make sure that you comply with the set laws and as an employee to make sure that you know your rights and situations that demand you enjoy health coverage.


HIPAA is beneficial to employees, but also guides employers on how to handle heath coverage offered to workers. It should be remembered that violation of the act can amount to hefty penalties.

 Business Attorney, Business Lawyer