subject: Hipaa, Health Insurance, And Discrimination [print this page] When one hears mention of HIPAA, they generally journey back in their mind to their last visit to a physician's office or hospital. Along with all the rest of the necessary paperwork, the HIPAA form becomes just one more thing to sign and date, making it more of an annoyance than anything else. However, when it comes to health insurance and discrimination, HIPAA becomes much more than another required signature.
HIPAA, or the Health Insurance Portability and Accountability Act, has a number of different umbrellas of provisions, one of which is to prevent discrimination against employees due to a variety of particular "health factors." These include a number of different factors, which apply both to the employee and any family members covered under the policy.
Individuals with current or previous medical conditions, either physical or mental, may not be denied coverage or charged more than "similarly situated individuals." Companies are permitted to make distinctions between certain groups of employees, such as those that work part-time and full-time, as well as between dependents if the differences are not based on a health factor. Anyone in an eligible group of "similarly situated individuals thus may not be charged more than someone else in their group.
Other health factors that are not allowed to be discriminated against include one's history of health insurance claims, obtained health care, current health status, and disability. Another factor that may not be discriminated against is "evidence of insurability," which includes conditions that arise as a result of domestic violence or some recreational activities such as skiing, motorcycling, horseback riding, and snowmobiling.
However, there is some relatively unclear leeway for health insurance companies to ensure that they are not left with outrageous medical bills due to a consumer's participation in a high-risk activity such as bungee jumping or sky-diving. In this case, a plan may exclude coverage for any medical costs resulting from this activity, but cannot exclude the consumer from being covered by the rest of the plan's benefits.
Any and all pieces of genetic information also may not affect any health insurance plan. The Genetic Information Nondiscrimination Act of 2008 (GINA), prohibits insurers from increasing group premiums based on any genetic information of any enrolled consumers. In addition, previous HIPAA legislation prohibited the practice of singling out any employees for exclusions or higher rates due to genetic predispositions.
Do keep in mind, however, that it is legal for an insurance company to require the completion of a physical examination as a requirement for enrollment. Information from this exam may not be used to restrict enrollment or increase premiums, though.
Some companies also require the completion of a detailed questionnaire in regards to medical history. This is also perfectly legal as long it has no affect on any restrictions or premiums. Any that require a certain "score" are practicing illegal methods and should be reported to a HIPAA enforcement officer or the state insurance board.
As may be seen, HIPAA is one of the first stepping stones in improving our health care system, and it is with glimmers of hope that consumers look to the future of health care.
by: Casey Trillbar
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