Final Rule for Nondiscrimination and Wellness Programs in Health Coverage in the Group Market
The Department of Health and Human Services (HHS) published final rules December 13, 2006 to provide guidance for compliance with nondiscrimination provisions of the Health Information Portability and Accountability Act (HIPAA) and the implementation of wellness programs. HIPAA's nondiscrimination provisions generally prohibit a group plan or group health insurance issuer from denying an individual eligibility for benefits based on health factors and from charging a higher premium than a similarly eligible individual based on health factors. Generally these final rules do not change the interim rules published in 2001, but they do clarify how the source-of-injury rules apply to the timing of diagnosis of a medical condition and add examples to illustrate how benefits rules apply. Health factors are identified in the rule as meaning health status; medical conditions (including both physical and mental illnesses) defined in claims experience, receipt of health care, medical history, genetic information, evidence of insurability, or disability. The Employee Benefits Security Administration in the Department of labor has updated their information on frequently asked questions for HIPAA nondiscrimination requirements to assist in compliance of the new rules. The new rules become effective on the first day of the plan year beginning on or after July 1, 2007. For calendar year plans, the new rules will apply beginning January 1, 2008.
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