Health Insurance Portability and Accountability Act (HIPAA)

The U.S. Congress enacted the Health Insurance Portability and Accountability Act (HIPAA, P.L. 104-191) in 1996. It is composed of two parts; Title I and Title II. Title I of HIPAA protects the health insurance of workers and their families when they change or lose their jobs.  It also regulates the availability and scope of group health plans and some individual health insurance policies.  In addition, it amends The Employee Retirement Income Security Act, the Public Health Service Act, and the Internal Revenue Code. Title I also limits the restrictions a group health care plan can place on benefits for pre-existing conditions.

Title II of HIPAA is known as the Administrative Simplification (AS) provisions.  It requires the formulation of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers. It also addresses security and privacy issues of health data. In particular, the AS provisions put into effect 5 rules:

1.     Privacy rule,

2.     Transactions and Code sets rule,

3.     Security rule,

4.     Unique Identifiers rule, and

5.     Enforcement rule.

The provisions are intended to increase the efficiency and effectiveness of the nation’s health care system by encouraging the widespread use of electronic data interchange. Title II also describes numerous offenses relating to health care and establishes civil and criminal penalties for them. In addition, it creates several programs to restrain fraud and abuse within the health care system.

For more specifics on Titles I and II of HIPAA click the following link: › … › HIPAA - General Information

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