Private Health Insurance: Progress and Challenges in Implementing 1996 Federal Standards
HEHS-99-100
Published: May 12, 1999. Publicly Released: Jun 11, 1999.
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Highlights
Pursuant to a congressional request, GAO provided information on: (1) the implementation status of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) provisions in the group insurance market; (2) the price of coverage for certain individuals losing group insurance; (3) the extent of consumer understanding of HIPAA as well as federal, state, and private efforts undertaken to educate consumers about the law's protections; and (4) federal efforts undertaken to ensure HIPAA compliance.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Health Care Financing Administration | The Health Care Financing Administration (HCFA) and the Department of Labor should revise the model certificate of creditable health plan coverage to more explicitly inform consumers of their new rights under HIPAA. At a minimum, the model certificate should inform consumers about appropriate contacts for additional information and HIPAA and highlight key provisions and restrictions, including the (1) limits on preexisting condition exclusion periods and the guaranteed renewability of all health coverage (2) reduction or elimination of preexisting condition exclusion periods for employees changing jobs; (3) the prohibition against excluding an individual from an employer health plan on the basis of his or her health status, and (4) guarantee of access to insurance products for certain individuals losing group coverage and the restrictions placed on that guarantee. |
The Department of Health and Human Services, along with the Departments of Labor and the Treasury, developed a model certificate including material that educates consumers on their rights under HIPAA. This model certificate was included in final regulations issued December 30, 2004. In addition, CMS has developed a user-friendly, interactive web site that allows consumers to learn more about the rights HIPAA offers them, specifically the rights referred to in the GAO recommendation. CMS also has published and disseminated a booklet entitled "Protecting Your Health Insurance Coverage," which provides consumers with the type of information referenced in the GAO recommendation.
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| Department of Labor | The Health Care Financing Administration (HCFA) and the Department of Labor should revise the model certificate of creditable health plan coverage to more explicitly inform consumers of their new rights under HIPAA. At a minimum, the model certificate should inform consumers about appropriate contacts for additional information and HIPAA and highlight key provisions and restrictions, including the (1) limits on preexisting condition exclusion periods and the guaranteed renewability of all health coverage (2) reduction or elimination of preexisting condition exclusion periods for employees changing jobs; (3) the prohibition against excluding an individual from an employer health plan on the basis of his or her health status, and (4) guarantee of access to insurance products for certain individuals losing group coverage and the restrictions placed on that guarantee. |
DOL agrees with the recommendation and has developed a new model certificate. The model for an expanded certificate was included in the final HIPAA regulations developed jointly by Treasury, HHS, and DOL and issued December 30, 2004.
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| Health Care Financing Administration | To ensure that HCFA is able to fully perform its new oversight role under HIPAA, HCFA should promptly promulgate enforcement regulations. |
An interim final rule with comment period was published in the Federal Register on August 20, 1999, and made effective September 20, 1999.
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