What kinds of information do group health plans have to give to participants and beneficiaries under HIPAA?
HIPAA and other laws have made important changes under the Department of Labor disclosure rules. Under these rules, group health plans must improve the documents employers are required to give to employees at certain key intervals, such as summary plan descriptions (SPDs) and summaries of material modifications (SMMs) to make sure they:
- Inform participants and beneficiaries of “material reductions in covered services or benefits” (for example, reductions in benefits or increases in deductibles and co-payments), generally within 60 days after the change is adopted.
- Give participants and beneficiaries information about the role of issuers (such as insurance companies and HMOs) with respect to their group health plan. For instance, they must include the name and address of the issuer, whether and to what extent benefits under the plan are guaranteed under a contract or policy of insurance issued by the issuer, and the nature of any administrative services (for example, payment of claims) the issuer provides.
- Tell participants and beneficiaries which Department of Labor office they can contact for help or information on their rights under ERISA (Employee Retirement Income Security Act) and HIPAA.
- Tell participants and beneficiaries that federal law generally prohibits the plan and health insurance issuers from limiting hospital stays for childbirth to less than 48 hours for normal deliveries and 96 hours for Cesarean sections.
The new health care law (ACA) requires plans to provide a Summary of Benefits and Coverage (SBC), a short and simple summary of coverage with coverage examples that help people make “apples to apples” comparisons of different coverage options.
Can employers use e-mail to give this information to employees? If so, do employees still have a right to get a paper copy of their health plan information?
Yes to both questions. The disclosure rules provide a “safe harbor” for using electronic media (e-mail) to share summary plan descriptions (SPDs) and summaries of material modifications (SMMs). But employees must be able to get the electronic documents at their worksite (there are also some other requirements). Participants also have the right to get the information on paper free of charge when they ask for it.
- What Is HIPAA?
- HIPAA, pre-existing condition exclusions, and creditable coverage
- HIPAA, your health history, and health insurance coverage
- Making benefits claims
- HIPAA and certain policy provisions
- Information sharing
- Who enforces HIPAA?
- Getting and keeping health insurance coverage under HIPAA
- Glossary of terms
- To learn more