Health Insurance Portability and Accountability Act (29 U.S.C. s. 1181) (45 CFR Part 160) (45 CFR Part 164) (U.S. Department of Health and Human Services)

• Under a federal statute (HIPAA) the ability to deny health insurance to new employees because of preexisting conditions has been considerably limited. Employers and health insurance issuers may with respect to a participant or beneficiary impose a preexisting condition exclusion only if:
• The exclusion relates to a condition (whether physical or mental) for which the participant or beneficiary received medical advice, diagnosis or treatment within the last six months;
  
• The exclusion lasts for no more than 12 months after the enrollment date; and
  
• The length of the exclusion is also reduced by the period of time for which the participant or beneficiary had health insurance coverage before the enrollment date. (29 U.S.C. s. 1181(a))

• Under HIPAA health insurance issuers may not discriminate against individual participants or beneficiaries based on their:
• Health status;
  
• Medical condition (both physical and mental illnesses:
  
• Claims experience;
  
• Receipt of health care;
  
• Medical history;
  
• Genetic information;
  
• Evidence of insurability (including conditions arising out of acts of domestic violence); or
  
• Disabilty.(29 U.S.C. s. 1182(a))

• The HIPAA privacy rules protect an individual's health information and other identifying information by limiting the permissible uses and disclosure of such information by "covered entities" and "business associates" without an individual's authorization. (45 CFR Part 160) (45 CFR Part 164)

• This statute is enforced by the Secretary of Health and Human Services. (42 U.S.C. s. 1320d-5)


• In Payne v. Taslimi, 998 F.3d 648 (4th Cir. 2021), the Fourth Circuit Court of Appeals ruled that there is no private right of action under HIPAA.



 

 

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