U.S. Department of Labor
Health Benefits Advisor for Employers
The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Plan Compliance Results
The Health Insurance Portability and Accountability Act of 1996 (HIPAA), amended the Employee Retirement Income Security Act to provide new rights and protections for participants and beneficiaries in group health plans. HIPAA contains protections both for health coverage offered in connection with employment (group health plans) and for individual insurance policies sold by insurance companies (individual policies).
HIPAA includes protections for coverage under group health plans that:
- Prohibit discrimination against employees and dependents in group health plan eligibility, benefits, and premiums based on health factors; and
- Allow individuals a special opportunity to enroll in group health plan coverage under certain circumstances.
Based on your responses, your plan appears to be in compliance with the following HIPAA provisions:
Special Enrollment Provisions
Nondiscrimination Provisions
Wellness Program Provisions
- None.
MEWA or Multiemployer Plan Guaranteed Renewability Provisions
- None.
Based on your responses, your plan does NOT appear to be in compliance with the following HIPAA provisions:
Special Enrollment Provisions
Nondiscrimination Provisions
MEWA or Multiemployer Plan Guaranteed Renewability Provisions
- None.
Note: If you would like to review the information provided within this Advisor, you may select that issue above and it will take you back to that section in the Health Benefits Advisor where you can reread the description and answer the question again. This Advisor provides general guidance and users are encouraged to review their specific health plan or health plan options in conjunction with the general information provided. In addition, the Advisor does not address health benefits offered through Federal, state, or local government plans or church plans.
Determine compliance with other applicable ERISA Laws:
The following health laws under Title I of ERISA may apply to your employer sponsored group health plan. You may select the following laws to determine compliance.
- Consolidated Omnibus Budget Reconciliation Act (COBRA)
- Mental Health Parity Act (MHPA) and Mental Health Parity and Addiction Equity Act (MHPAEA)
- Newborns' and Mothers' Health Protection Act (Newborns' Act)
- Women's Health and Cancer Rights Act (WHCRA)
- Genetic Information Nondiscrimination Act (GINA)
- Michelle's Law
For more information on HIPAA visit:
- Compliance Assistance Guide
- HIPAA Self-Audit Checklist for Employers
- Reporting and Disclosure Guide For Employee Benefit Plans
- Fact Sheet
- Frequently Asked Questions About HIPAA
- Frequently Asked Questions About HIPAA - Nondiscrimination
- Chart of Required Notices
- HIPAA Model Notices
- Statute
- Regulations
For more information on Compliance Assistance visit:
The Affordable Care Act (ACA) provides additional health protections. This website does not reflect the passage of the ACA. For an overview of the Affordable Care Act, please visit the ACA Summary. For regulations, guidance and additional information, please visit the Department of Labor's ACA webpage.
