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Introduction to HIPAA

What is HIPAA?

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) impacts a wide variety of features of the U.S. health care system. Its best known and most important provisions affect the portability of health coverage, and the privacy and security of individuals’ personal health information. In summary, these provisions include:

Portability of Health Coverage

  • Limitations on group health plans excluding coverage of pre-existing conditions
  • Prohibitions on group health plans from discriminating by denying coverage or charging extra for coverage based on an employee or family member's past or present poor health
  • Rights for certain individuals to “special enroll” in a group health plan outside a plan’s open enrollment when coverage is lost due to certain life events, such as loss of other coverage, or marriage
  • Guarantees for certain small employers of the right to purchase health insurance

Privacy of Personal Health Information

Restricts the use of protected health information, including:

  • Information doctors, nurses, and other health care providers put in an individual’s medical record
  • Conversations a doctor has about a patient’s care or treatment with nurses and others
  • Information about individuals in their health insurer’s computer system
  • Billing information of individuals at clinics
  • Most other health information about individuals held by those who must follow these laws

Security of Personal Health Information

National standards to protect the confidentiality, integrity and availability of electronic protected health information.

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