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The Health Insurance Portability and Accountability Act of 1996 (HIPAA)

The Health Insurance Portability and Accountability Act of 1996 (HIPAA), amended the Employee Retirement Income Security Act (ERISA) to provide new rights and protections for participants and beneficiaries in group health plans. HIPAA contains protections both for health coverage offered in connection with employment (group health plans) and for individual insurance policies sold by insurance companies (individual policies).

HIPAA includes protections for coverage under group health plans that:

  • Limit exclusions for preexisting conditions;
  • Prohibit discrimination against employees and dependents in group health plan eligibility, benefits, and premiums based on health factors; and
  • Allow individuals a special opportunity to enroll in group health plan coverage under certain circumstances.

Remember, HIPAA coverage requires 2 or more participants who are current employees on the first day of that plan year.

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