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Employee Benefits Security Administration

Fact Sheet

Health Care Access, Portability, and Renewability Provisions of the Health Insurance Portability and Accountability Act

EBSA plans to enhance health benefit security by publishing additional regulatory guidance regarding health coverage access and portability provisions of the Health Insurance Portability and Accountability Act (HIPAA), supporting the Secretary's good jobs for everyone policy.

Key Action: Final Regulation

In September 2010, the Department's EBSA plans to finalize a previously proposed regulation regarding the portability of health coverage, as well as address amendments made to HIPAA by Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA).

Key Concerns and Issues to be Addressed

The final regulation will provide additional guidance regarding health coverage access and portability. Provisions regarding new special enrollment opportunities for children and their families will also be addressed.

Background

HIPAA offers protections for millions of American workers that improve portability and continuity of health insurance coverage. Among other things, HIPAA protects workers and their families by limiting preexisting condition exclusions in group health plan coverage and providing new special enrollment rights. HIPAA's special enrollment rights allow individuals to enroll in their employer's health plan when they lose eligibility for certain other health coverage (such as a spouse's plan), get married, or have a new dependent through birth, adoption, or placement for adoption. CHIPRA expanded these special enrollment rights. Under CHIPRA, health plans must also permit special enrollment when losing eligibility for coverage under a State Medicaid or CHIP program. Moreover, new special enrollment opportunities also exist if an employee or dependent becomes eligible for premium assistance under a State Medicaid or CHIP program. The employee or dependent must request coverage within 60 days of being terminated from Medicaid or CHIP coverage or within 60 days of being determined to be eligible for premium assistance. There are also new notice and disclosure requirements associated with CHIPRA.