Table 2.  Weighted Summary of Violation Rates

Statute - Measure

Large

Small

Multi

All

700 - Part 7 Provisions

Plans subject to statute

91,459

1,217,807

1,759

1,311,026

Plans with violations

46,048

547,086

1,058

594,192

Weighted violation rate

50.3%

44.9%

60.1%

45.3%

700.1 - HIPAA Violations

Plans subject to statute

91,459

1,217,807

1,759

1,311,026

Plans with violations

36,890

432,723

879

470,493

Weighted violation rate

40.3%

35.5%

50.0%

35.9%

700.2 - Mental Health Parity Act Violations

Plans subject to statute

81,458

194,725

1,670

277,854

Plans with violations

6,488

15,454

332

22,274

Weighted violation rate

8.0%

7.9%

19.9%

8.0%

700.3 - Newborns' and Mothers' Health Protection Act Violations

Plans subject to statute

39,220

343,088

1,309

383,617

Plans with violations

7,406

126,726

281

134,413

Weighted violation rate

18.9%

36.9%

21.4%

35.0%

700.4 - Women's Health and Cancer Rights Act Violations

Plans subject to statute

91,459

1,217,807

1,759

1,311,026

Plans with violations

16,964

268,907

303

286,174

Weighted violation rate

18.5%

22.1%

17.2%

21.8%

Table 3.  95% Confidence Limits for Weighted Violation Rates in All Plans
Confidence Limits for Violation Rates

Statute

Violation Rate

Standard Error

Lower 95% Confidence Limit

Upper 95% Confidence Limit

700 - Part 7 Provisions

45%

2.3%

41%

50%

700.1 - HIPAA Violations

36

2.2

31

40

700.2 - Mental Health Parity Act Violations

8.0

2.4

3.3

13

700.3 - Newborns' and Mothers' Health Protection Act Violations

35

4.1

27

43

700.4 - Women's Health and Cancer Rights Act Violations

22

1.9

18

26

Table 4A.  95% Confidence Limits for Weighted Violation Rates in Each Sample
Confidence Limits for Violation Rates
Sample=Large

Statute

Violation Rate

Standard Error

Lower 95% Confidence Limit

Upper 95% Confidence Limit

700 - Part 7 Provisions

50%

2.4%

46%

55%

700.1 - HIPAA Violations

40

2.3

36

45

700.2 - Mental Health Parity Act Violations

8.0

1.4

5.3

11

700.3 - Newborns' and Mothers' Health Protection Act Violations

19

2.9

13

25

700.4 - Women's Health and Cancer Rights Act Violations

19

1.9

15

22

Table 4B.  95% Confidence Limits for Weighted Violation Rates in Each Sample
Confidence Limits for Violation Rates
Sample=Small

Statute

Violation Rate

Standard Error

Lower 95% Confidence Limit

Upper 95% Confidence Limit

700 - Part 7 Provisions

45%

2.5%

40%

50%

700.1 - HIPAA Violations

36

2.4

31

40

700.2 - Mental Health Parity Act Violations

7.9

3.4

1.1

15

700.3 - Newborns' and Mothers' Health Protection Act Violations

37

4.6

28

46

700.4 - Women's Health and Cancer Rights Act Violations

22

2.1

18

26

Table 4C.  95% Confidence Limits for Weighted Violation Rates in Each Sample
Confidence Limits for Violation Rates
Sample=Multi

Statute

Violation Rate

Standard Error

Lower 95% Confidence Limit

Upper 95% Confidence Limit

700 - Part 7 Provisions

60%

2.2%

56%

64%

700.1 - HIPAA Violations

50

2.2

46

54

700.2 - Mental Health Parity Act Violations

20

1.8

16

23

700.3 - Newborns' and Mothers' Health Protection Act Violations

21

2.1

17

26

700.4 - Women's Health and Cancer Rights Act Violations

17

1.7

14

20

Table 5A.  Violation Rates for Single-Employer Plans by Statute and Plan Size
(Weighted Violation Rates)

Number of Participants

700
Part 7
Provisions

700.1
HIPAA
Violations

700.2
Mental Health Parity Act Violations

700.3
Newborns' and Mothers' Health Protection Act Violations

700.4
 Women's Health and Cancer Rights Act Violations

# of Cases

Violation Rate

# of Cases

Violation Rate

# of Cases

Violation Rate

# of Cases

Violation Rate

# of Cases

Violation Rate

None or not reported

12

23.2%

12

1.5%

4

0.0%

2

50.0%

12

10.9%

2-9

208

43.2

208

34.3

11

27.3

50

44.8

208

20.6

10-24

108

48.8

108

40.6

11

5.9

33

35.6

108

23.0

25-99

169

52.3

169

40.3

101

5.6

52

41.3

169

31.0

100-500

212

46.0

212

33.0

205

8.3

101

7.5

212

15.9

500 or more

154

37.0

154

34.9

152

1.9

84

14.2

154

10.9

All

863

45.3

863

35.9

484

7.9

322

35.1

863

21.8

Table 5B.  Violation Rates for Multi-employer Plans by Statute and Plan Size
(Weighted Violation Rates)

Number of Participants

700
Part 7
Provisions

700.1
HIPAA
Violations

700.2
Mental Health Parity Act Violations

700.3
Newborns' and Mothers' Health Protection Act Violations

700.4
 Women's Health and Cancer Rights Act Violations

# of Cases

Violation Rate

# of Cases

Violation Rate

# of Cases

Violation Rate

# of Cases

Violation Rate

# of Cases

Violation Rate

2-99

34

50.0%

34

44.1%

18

22.2%

16

18.8%

34

11.8%

100-499

111

52.3

111

41.4

109

15.6

84

22.6

111

14.4

500-999

95

68.0

95

53.1

93

21.8

74

26.1

95

25.0

1,000-4,999

122

67.9

122

60.5

121

23.3

95

20.1

122

17.6

5,000 or more

54

51.3

54

42.0

54

16.8

41

14.8

54

12.0

All

416

60.1

416

50.0

395

19.9

310

21.4

416

17.2

Table 6.  Detailed Violation Rates by Sample
(Weighted Violation Rates)

Violation

Large

Small

Multi

All

700 - Part 7 Provisions

50.3%

44.9%

60.1%

45.3%

700.1 - HIPAA Violations

40.3

35.5

50.0

35.9

H1 - Impermissible preexisting condition exclusion

26.5

23.6

31.8

23.8

701(a)(1) - 6-Month look-back violation

12.3

11.7

17.2

11.7

701(a)(1) [using 701(b)(1) definition] - Preex on genetic information

0.0

0.5

1.0

0.5

701(a)(2) - 12 Month (or 18 month) look-forward violation

10.4

9.4

18.4

9.5

701(a)(3) [using 701(c) definition] - Failure to offset

6.4

6.3

9.7

6.4

701(d)(1) - Impermissible preex on newborns

1.2

0.5

4.6

0.6

701(d)(2) - Impermissible preex on children adopted or placed for adoption

1.3

0.8

4.4

0.8

701(d)(3) - Pregnancy preex

1.4

3.3

5.1

3.2

29 CFR 2590.701-3(c) - Failure to give adequate generalized notices of preex

15.5

14.5

18.6

14.5

29 CFR 2590.701-5(d) - Failure to give adequate individualized notices of preex

11.7

10.4

10.9

10.5

Other - Impermissible preex

6.5

4.8

6.6

4.9

H2 - Failure to Provide Certificates

9.5

7.1

11.5

7.3

701(e)(1)(A)(i) - Automatically upon loss of coverage (COBRA covered plan)

4.0

0.8

5.6

1.0

701(e)(1)(A)(i) - By Plan (COBRA Covered)

3.0

0.8

5.3

0.9

701(e)(1)(A)(i) - By Issuer only pursuant to agreement (COBRA Covered)

1.0

0.0

0.2

0.1

701(e)(1)(A)(ii) - Automatically upon loss of coverage (Non COBRA Covered)

0.5

2.3

0.5

2.2

701(e)(1)(A)(ii) - By Plan (Non COBRA Covered)

0.2

2.3

0.5

2.1

701(e)(1)(A)(ii) - By Issuer only pursuant to agreement (Non COBRA Covered)

0.2

0.0

0.0

0.0

701(e)(1)(A)(iii) - Upon request

2.6

2.8

1.9

2.8

701(e)(1)(A)(iii) - By Plan (Upon Request)

1.6

2.5

1.9

2.5

701(e)(1)(A)(iii) - By Issuer only pursuant to agreement (Upon Request)

1.0

0.3

0.0

0.3

29 CFR 2590.701 - 5(a)(2) - Within required time frames

2.7

0.8

2.4

0.9

29 CFR 2590.701 - 5(a)(2) - By Plan (W/In Req'd Timeframes)

2.2

0.8

2.2

0.9

29 CFR 2590.701 - 5(a)(2) - By Issuer with agreement (W/In Req'd Timeframes)

0.5

0.0

0.2

0.0

Other - Failure to Provide Certificates

3.6

2.5

4.7

2.6

H3 - Special Enrollment Violation

10.9

16.2

15.5

15.9

701(f)(1) - Failure to allow special enrollment upon loss of other coverage

3.1

5.3

3.6

5.2

701(f)(2) - Failure to allow dependant special enrollment

2.1

3.0

3.1

3.0

29 CFR 2590.701-6(c) - Failure to give notice of special enrollment rights

7.8

12.4

12.3

12.1

Other - Special Enrollment Violation

1.5

1.5

0.5

1.5

H4 - Nondiscrimination Violation

13.2%

6.9%

23.0%

7.3%

702(a) - Nonconfinement clause that delays eligibility

9.2

4.6

17.7

4.9

702(a) - Other violation of eligibility discrimination provision

5.0

3.6

6.3

3.7

702(b) - Nonconfinement clause that raises premiums

0.0

0.0

0.0

0.0

702(b) - Other violation of premium discrimination provision

0.2

0.0

0.0

0.0

Other - Nondiscrimination Violation

1.9

0.3

1.0

.04

H5 - 701(g) - HMO Affiliation Period Violation

0.0

0.0

0.0

0.0

H6 - 703 - MEWA or Multiemployer Plan Failure to Provide Guaranteed Renewability

0.0

0.0

0.0

0.0

700.2 - Mental Health Parity Act Violations

8.0

7.9

19.9

8.0

Not Subject to Mental Health Parity Act

10.9

84.0

5.1

78.8

Mental Health Parity Act Violation

8.0

7.9

19.9

8.0

M1 - 712(a)(1) - Lifetime Dollar Limit

4.1

3.2

6.1

3.5

M2 - 712(a)(1) - Constructive (Straight math) Lifetime Dollar Limit

0.5

1.6

1.3

1.3

M3 - 712(a)(2) - Annual Dollar Limit

4.1

4.8

6.4

4.6

M4 - 712(a)(2) - Constructive (Straight math) Annual Dollar Limit

2.6

4.8

10.7

4.2

M5 - 29 CFR 2590.712(b)(4) - Substance Abuse Offsets Mental Health Limit

1.6

4.8

2.5

3.8

M6 - Other

0.5

0.0

0.0

0.2

700.3 - Newborns' and Mothers' Health Protection Act Violations

18.9

36.9

21.4

35.0

Not Subject to Newborns' and Mothers' Health Protection Act

57.1

71.8

25.6

70.7

Newborns' and Mothers' Health Protection Act Violations

18.9

36.9

21.4

35.0

N1 - 711(a)(1)(A) - Violation of 48/96 Hour Stay Rule

1.6

3.6

1.3

3.4

N2 - 711(a)(1)(B) - Provider Required to Obtain Authorization From Plan

1.7

2.7

1.6

2.6

N3 - 711(b) - Incentives to Mothers or Doctors

0.0

0.9

0.6

0.8

N4 - 711(d) - Notice Violation

17.8

34.2

20.8

32.5

N5 - Other

0.0

0.0

0.0

0.0

700.4 - Women's Health and Cancer Rights Act Violations

18.5

22.1

17.2

21.8

Not Subject to Women's Health and Cancer Rights Act

0.9

1.5

0.7

1.5

Women's Health and Cancer Rights Act Violations