Group Health Plan Requirements
This page
covers the following group health plan requirements under HIPAA:
- Overview
- Nondiscrimination Requirements
- Special Enrollment Rights Provisions
- Preexisting Condition Exclusion Prohibition
Overview
Under HIPAA,
group health plans are subject to certain nondiscrimination, special
enrollment, and preexisting condition requirements. These requirements are
explained in detail below.
Nondiscrimination Requirements
Under HIPAA, an individual cannot be denied eligibility for benefits or
charged more for coverage because of any health factor. However, distinctions among groups of similarly
situated participants in a health plan may
be permitted if they are based on bona-fide employment-based classifications
consistent with the employer's usual business practice.
Health
Factors
Under HIPAA, an
individual cannot be denied eligibility for benefits or charged more for
coverage because of any health factor. "Health factors" include: