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What is HIPAA?

 HIPAA stands for the Health Insurance Portability and Accountability Act of 1996. It seeks to address and standardize a broad range of activities by health insurance companies and health care providers. HIPAA includes five specific provisions, or titles.

They are:

Title I – Health care access, portability, and renewability

Title II – Preventing health care fraud and abuse, administrative simplification, and medical liability reform

Title III – Tax-related health provisions

Title IV – Application and enforcement of group health plan requirements

Title V – Revenue offset provisions

The intent of the federal HIPAA laws and corresponding Wisconsin legislation is to decrease the cost of health care and protect the privacy of personal health information.

What HIPAA Does Not Provide

• HIPAA does not address the issue of the cost of insurance coverage.

• HIPAA does not require that your employer offer health insurance to its employees.

• HIPAA does not require that your employer offer comparable coverage to the coverage you had in the past.

• HIPAA does not require that an insurance plan cover all your medical costs or cover all your medical conditions.

• HIPAA does not require that health insurance companies accept your application for an individual  insurance policy when you do not meet their underwriting standards.

Who Is Affected?

 HIPAA applies to health plans and health care providers. Health plans include plans offered by insurance companies, health maintenance organizations (HMOs), and limited service health organizations.

 How Do the Privacy of Health Information Provisions Affect Me?

Both federal and state laws offer some protection of your personal medical information. The federal privacy laws apply to both health care providers and insurance companies. More information on the federal privacy laws can be obtained by visiting the United States Department of Health and Human Services Web site at www.hhs.gov/ocr/hipaa. Wisconsin insurance law includes requirements that insurance companies must meet when obtaining and using your personal medical information. Insurance companies may require your personal medical information in two situations. 

First, it is often necessary for an insurance company to review your medical records to determine the risk (how much it will cost to pay potential claims) associated with offering insurance coverage to you. Second, it is often necessary for an insurance company to review your medical records to determine whether the claims you submit for payment are eligible for coverage under the terms of the policy.  An insurance company cannot obtain your personal medical information without your written consent. An insurance company can either request written consent at the time of your application for coverage or as it finds necessary for the processing of a claim for benefits under your policy. If an insurance company obtains a signed disclosure authorization as part of the application for coverage, it must indicate in the disclosure authorization the purposes for which the disclosed personal medical information will be used. A disclosure authorization authorizing the company to obtain personal medical information for the purpose of making coverage decisions cannot be valid for longer than 30 months from the date on which it is signed. However, an authorization authorizing the company to obtain personal medical information in connection with a claim for benefits is valid for as long as your policy is in force and until all claims pending under the policy are processed.

If an insurance company requests written consent to obtain your personal medical information only as it finds necessary for the processing of a particular claim or claims, it must obtain a signed disclosure authorization each time it requires an individual’s personal medical information.

What Are My Rights?

 • You have the right to refuse an insurance company access to your personal medical information. However, doing so may result in the insurance company having insufficient information to determine eligibility for coverage, premium rates, or policy benefits.

 • You have the right to request all personal medical information regarding you and your minor dependents in an insurance company’s possession.

 • You have the right to request the correction, amendment, or deletion of any personal medical information regarding you or your minor dependents in an insurance company’s possession.