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Archived News Release--Caution: information may be out of date.

EBSA Press Release: Labor Department Issues Two Technical Bulletins to Clarify Group Health Coverage Rules Under HIPAA [12/29/1997]

For more information call: (202) 219-8921

The U.S. Department of Labor today issued two Technical Bulletins to clarify interim rules issued April 8, 1997, under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

The first notice, ERISA Technical Release 97-01, clarifies the application of the HIPAA portability provisions to flexible spending arrangements (FSA). The release clarifies that it is appropriate to treat benefits under certain health flexible spending arrangements as excepted benefits for purposes of HIPAA's portability provisions.

The notice also clarifies that if a health FSA is offered in conjunction with another group health plan and if the employer contributions do not exceed a specified amount, the benefits under the health FSA will be considered excepted benefits. Accordingly, the coverage under the FSA will not be creditable coverage, and the FSA is not required to issue certificates for the coverage.

Typically, reimbursements under a health FSA provide coverage for medical care expenses not otherwise covered by the employer's primary group health plan.

The second notice, ERISA Technical Release 97-02, addresses certain issues arising under the portability provisions added by HIPAA. The notice clarifies certain rights of individuals who were denied coverage prior to July 1, 1997, the effective date of the provisions, under a group health plan because of a health status-related factor. Under HIPAA's nondiscrimination provisions and the implementing regulations, neither a group health plan nor group health insurance coverage can exclude such individuals from enrolling in the plan or coverage.

HIPAA interim regulations, issued April 8, 1997, explained that an employee or dependent cannot be denied coverage under a group health plan or group health insurance coverage because of health status on or after the effective date of HIPAA. The regulations made it clear that an employee or dependent cannot be required to pass a physical examination as a condition of enrollment, even if the individual is a late enrollee.

The two Technical Bulletins are available on the Internet at http://www.dol.gov/pwba/.

Archived News Release--Caution: information may be out of date.