Quick Reference to HIPAA Compliance 2003

Quick Reference to HIPAA Compliance 2003

by Pamela Sande, Joan Vigliotta


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Product Details

ISBN-13: 9780735537682
Publisher: Wolters Kluwer Law & Business
Publication date: 08/20/2003
Pages: 602

Table of Contents

1About This Guide1
3Covered Plans1
A.Group Health Plans2
B.Exempt Plans4
C.Excepted Benefits5
4Limitations on Preexisting Condition Exclusions1
A.General Rules2
B.Six-Month Look-Back Rule3
C.Look-Forward Rule6
D.Enrollment Definitions7
E.Creditable Coverage Rules10
F.Standard Method12
G.Alternative Method16
H.Certifying Coverage; General Rules20
Job Aid: Deadlines for Providing Certificates23
I.Certifying Coverage; Form and Content Requirements24
Job Aid: Certificate Content Checklist27
Job Aid: Model Certificate28
Job Aid: Model Certificate for Categories of Benefits (Alternative Method)29
J.Certifying Coverage; Procedural Requirements30
K.Demonstrating Creditable Coverage32
L.Determination and Notice of Creditable Coverage35
M.Exceptions to Preexisting Condition Exclusions37
N.Special Enrollment Periods for Individuals Who Lose Other Coverage39
O.Special Enrollment Periods for Dependents42
Job Aid: Notice of Enrollment Rights; Model Description45
P.HMO Affiliation Periods46
5Nondiscrimination Rules1
A.Nondiscrimination in Eligibility2
B.Nondiscrimination in Benefits5
C.Nondiscrimination in Premiums or Contributions9
D.Special Rules and Exceptions11
E.Multi-employer and Multiple Employer Plans17
6Reporting and Disclosure Requirements1
A.Notice to Employees2
B.SPD Requirements5
7Rules for Group Health Insurers1
A.Guaranteed Renewability Requirements2
B.Guaranteed Availability Requirements5
C.Disclosure Requirements9
8Rules for Individual Health Insurers1
A.Guaranteed Availability2
B.Limits and Exceptions3
C.Guaranteed Renewability7
D.Certifying Coverage; General Rules10
E.Certifying Coverage; Form and Content Requirements11
Job Aid: Certificate Content Checklist14
Job Aid: Model Certificate15
F.Certifying Coverage; Procedural Requirements16
9Administrative Simplification1
A.Privacy Rules2
B.Electronic Transaction Rules5
10Penalties for Noncompliance1
A.General Information2
B.IRC Penalties; Corrections and Waivers4
C.IRC Penalties; Minimum and Maximum Amounts5
11HIPAA and Other Laws1
A.State Insurance Laws and ERISA Preemption2
B.Consolidated Omnibus Budget Reconciliation Act4
Job Aid: Life Events Compliance Checklist23
C.Health Flexible Spending Accounts25
12Other Major Health Plan Reform1
A.Consolidated Omnibus Budget Reconciliation Act2
B.Mental Health Parity Act5
C.Newborns' and Mothers' Health Protection Act8
D.Women's Health and Cancer Rights Act11
13Text of Law1
A.Internal Revenue Code Provisions2
B.ERISA Provisions23
C.Public Health Service Act Provisions48
14Regulations, Notices, and Other Government Publications1
A.HIPAA Interim Rules2
B.Corrections to HIPAA Interim Rules116
C.Application of HIPAA Rules to FSAs and to Individuals Denied Coverage Because of Health Status130
D.HIPAA Interim Final Rules and Proposed Rules135
E.Notice of Changes Under HIPAA to COBRA180
F.ERISA Technical Release No. 97-01183
G.ERISA Technical Release No. 97-02187
H.HIPAA Final Rules, Privacy Standards191
I.HIPAA Final Rules, Security Standards285
J.HIPAA Interim Rules, Penalties334

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