HIPAA Portability Procedures Manual & E-Alerts

Agenda

Introduction To HIPAA

• Portability And Availability Regulations
• Group Market Provisions
• Regulatory Matrix
• Regulatory Penalties
• Purpose Of HIPAA
• Benefits Subject To HIPAA: Group Health Plans
• Benefits Not Subject To HIPAA: Excluded Benefits
• Benefits Not Subject To HIPAA: Excepted Benefits
• Benefits Not Subject To HIPAA: Section 125 Health Flexible Spending Arrangements
• Benefits Not Subject To HIPAA: Other Benefits
• Benefits Not Subject To HIPAA: Non-Federal Government Plans

Preexisting Conditions And Creditable Coverage

• Pre-Existing Conditions
• Enrollment Date And Waiting Periods
• Elimination Of The Prudent Person Rule
• Maximum Periods For Pre-Existing Condition Exclusions
• HMO Affiliation Periods
• Other Restrictions On Pre-Existing Condition Exclusions
• Definition Of Creditable Coverage
• Application Of Creditable Coverage
• Significant Breaks In Coverage
• Methods For Counting Creditable Coverage
• Types Of Certificates Of Creditable Coverage
• Delivery Of Certificates Of Creditable Coverage
• Lack Of Certificates Of Creditable Coverage
• Responsibilities For Providing Certificates Of Creditable Coverage
• Form And Content Of Certificates Of Creditable Coverage
• Processing Certificates Of Creditable Coverage

HIPAA Special Enrollments

• Introduction To HIPAA Special Enrollments
• Special Enrollments
• Special Enrollments: COBRA Qualified Beneficiaries
• Special Enrollments: QMCSO

HIPAA Notice Requirements

• Introduction To HIPAA Notices
• Notice Of Plan's Pre-Existing Conditions Exclusions
• Notice Of Determination Of Pre-Existing Condition Exclusions
• Notice Of Special Enrollment Rights
• Notice Of Use Of The Alternative Method

Nondiscrimination

• Nondiscrimination: Health-Related Factors
• Nondiscrimination: Eligibility Rules
• Nondiscrimination: Bona Fide Employment Classifications
• Nondiscrimination: Nonconfinement
• Nondiscrimination: Actively-At-Work Clauses
• Nondiscrimination: More Favorable Treatment
• Nondiscrimination: Bone Fide Wellness Programs

HIPAA And Other Laws

• HIPAA's Impact On COBRA
• Other Heath Care Mandates

Insurance Market Provisions

• Insurance Market Provisions: Guaranteed Availability Of Small Group Plans
• Insurance Market Provisions: Guaranteed Renewability
• Insurance Market Provisions: Individual Market Requirements

Sample Forms & Notices

• Model Certificate Of Coverage From HIPAA Regulations
• Model Certificate For Use In Determining Categories of Benefits
• Sample Notice Of Plan's Pre-Existing Condition Exclusions
• Sample Notice Of Determination Of Pre-Existing Condition Exclusions