What You Need to Know About HIPAA and Federal Nondiscrimination Laws

Two issues hit close to home for most people: privacy and equality or fair treatment. Our federal government has enacted legislation and put regulations in place to protect an individual’s right to keep medical information private. In addition, those laws closely correlate to federal nondiscrimination laws. It’s important for employers and plan administrators to understand the nexus between HIPAA and federal nondiscrimination laws while preparing and managing their employee benefit health care plans.

HIPAA and Your Privacy

The Health Insurance Portability and Accountability Act of 1996, as amended (“HIPAA”) relates to electronic medical transactions, unique identifiers, and security. HIPAA was enacted in part to protect health insurance for workers who lose or change jobs. Another primary reason for HIPAA was maintenance of confidentiality over health-related information.

In its current form, HIPAA protects workers and their families from being denied eligibility or health care benefits due to factors like:

  • Medical history,
  • Claims experience,
  • Pre-existing medical conditions, or
  • Disabilities.

Preventing discrimination based on an individual’s health care data is another connection between HIPAA and federal nondiscrimination laws.

The Affordable Care Act

Section 1557 of the Patient Protection and Affordable Care Act prohibits discrimination based on race, color, national origin, sex, age, or disability in some programs. For example, individuals who participate in the following programs receive nondiscrimination protections:

  • Health programs or activities that receive funding from HHS;
  • Health programs or activities that HHS administers; and
  • Insurance plans offered by insurers that participate in the health insurance marketplaces.

How can employers and plan administrators ensure their employee health care plans follow laws regarding discrimination?

Avoid Violating Nondiscrimination Laws

HIPAA and the Affordable Care Act prevent two types of discrimination, one based on medical data and the other on factors like age, sex, or race. The Office of Civil Rights enforces nondiscrimination laws for programs that receive financial assistance from HHS. Violations can lead to corrective action including retraining and significant penalties and fines, ranging from $100 to $50,000 per violation with a maximum penalty per violation of $1.5 million.

Employers and plan administrators can take steps to prevent violations of nondiscrimination laws as follows:

  • Properly train employees who deal with health care benefits. Anyone dealing with workers and their medical information should understand the importance of providing equal and confidential assistance.
  • Make sure your plan complies with HIPAA and ACA discrimination laws. Consult with an attorney who understands the consequences of noncompliance with benefit laws.

Learn More About HIPAA and Federal Nondiscrimination Laws

At Hall Benefits Law, we work extensively with employee benefit plans and help plan sponsors avoid violation of nondiscrimination laws. Please call us at 678-439-6236 to discuss your concerns with an experienced attorney. Our website contains more information about our firm, a Contact Form, and free resources for your review. From our home office in Georgia, we assist clients throughout the United States, from New York to New Mexico to California.

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Hall Benefits Law, LLC

HBL offers employers comprehensive legal guidance on benefits in mergers and acquisitions, Employee Stock Ownership Plans (ESOPs), executive compensation, health and welfare benefits, healthcare reform, and retirement plans. We counsel a wide spectrum of clients including small, mid-sized, and large companies, 401(k) investment advisors, health insurance brokers, accountants, attorneys, and HR consultants, just to name a few. HBL is passionate about advising clients, and we are dedicated to our mission: to provide comprehensive, personalized, and practical ERISA and benefits legal solutions that exceed client expectations.

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