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Health Care Coverage - Overview of
Laws
EMPLOYEE BENEFITS
SECURITY ADMINISTRATION
eLaws- Health Benefits Advisor
Laws, Regulations, Publications and Related Links
www.dol.gov/elaws/ebsa/health/7.asp
Site provides links to statues, regulations, fact sheets, and publications
for federal health care coverage laws:
- Employee Retirement Income Security Act of 1974 (ERISA)
- Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA),
- The Health Insurance Portability and Accountability Act (HIPAA),
- Newborns' and Mothers' Health Protection Act (Newborns' Act)
- Mental Health Parity Act (MHPA)
- Women's Health and Cancer Rights Act (WHCRA)
COBRA - Consolidated Omnibus Budget Reconciliation Act
COBRA is an acronym for the federal law that provides many employees
with rights to continue health care coverage after they no longer
qualify. When you no longer qualify for your employer's health care
coverage, the law may provide a way for you to continue that coverage
for a limited period of time. The right to continue coverage may
be provided under federal and/or state law. In order to know whether
federal and/or state laws apply, you need to know if you are in
a self-insured or fully insured plan.
- DEPARTMENT OF LABOR
COBRA – Health Benefits Under the Consolidated Omnibus Budget
Reconciliation Act
http://www.dol.gov/pwba/pdf/cobra99.pdf
COBRA gives workers and their family members who lose their health
benefits in certain circumstances the right to choose to continue
group health benefits provided by their health plan. This publication
provides a detailed overview of the law (PDF).
ERISA - Employee
Retirement Income Security Act
The Employee Retirement Income Security Act of 1974 (ERISA) is a
federal law that sets minimum standards for most voluntarily established
pension and health plans in private industry to provide protection
for individuals in these plans. ERISA does not cover group health
plans established or maintained by governmental entities, churches
for their employees, or plans which are maintained solely to comply
with applicable workers compensation, unemployment, or disability
laws. ERISA also does not cover plans maintained outside the United
States primarily for the benefit of nonresident aliens or unfunded
excess benefit plans.
HIPAA - Health
Insurance Portability and Accountability Act
Povides rights and protections for participants and beneficiaries
in group health plans. HIPAA includes protections for coverage under
group health plans that limit exclusions for preexisting conditions;
prohibit discrimination against employees and dependents based on
their health status; and allow a special opportunity to enroll in
a new plan to individuals in certain circumstances. HIPAA may also
give you a right to purchase individual coverage if you have no
group health plan coverage available, and have exhausted COBRA or
other continuation coverage.
MHPA - Mental
Health Parity Act
The Mental Health Parity Act (MHPA) provides for parity in the application
of aggregate lifetime and annual dollar limits on mental health
benefits with dollar limits on medical/surgical benefits. A plan
that does not impose an annual or lifetime dollar limit on medical
and surgical benefits may not impose such a dollar limit on mental
health benefits offered under the plan. MHPA does not apply to benefits
for substance abuse or chemical dependency. Health plans are not
required to include mental health benefits in their benefits package.
MHPA only applies to those plans that do offer mental health benefits.
Newborns' Act
- Newborns' & Mothers' Protections
The Newborns' and Mothers' Health Protection Act (Newborns' Act)
includes important protections for mothers and their newborn children
with regard to the length of the hospital stay following childbirth.
The Newborns' Act requires that group health plans that offer maternity
coverage pay for at least a 48-hour hospital stay following childbirth
(96-hour stay in the case of Cesarean section).
Womens' Health
& Cancer Rights Protections
The Women's Health and Cancer Rights Act (WHCRA) includes protections
for individuals who elect breast reconstruction in connection with
a mastectomy. WHCRA provides that group health plans and health
insurance issuers that provide coverage for medical and surgical
benefits with respect to mastectomies must also cover certain post-mastectomy
benefits, including reconstructive surgery and the treatment of
complications (such as lymphedema).
• Health
Care Coverage - HIPAA/ Insurance Portability
US DEPARTMENT OF LABOR
HIPAA- Health Insurance Portability and Accountability Act
Portability of Health Coverage
http://www.dol.gov/dol/topic/health-plans/portability.htm
The Health Insurance Portability and Accountability Act (HIPAA)
provides rights and protections for participants and beneficiaries
in group health plans. HIPAA includes protections for coverage under
group health plans that limit exclusions for preexisting conditions;
prohibit discrimination against employees and dependents based on
their health status; and allow a special opportunity to enroll in
a new plan to individuals in certain circumstances. HIPAA may also
give you a right to purchase individual coverage if you have no
group health plan coverage available, and have exhausted COBRA or
other continuation coverage.
CMS- Health Insurance Portability and Accountability Act
http://www.cms.hhs.gov/hipaa/hipaa1/default.asp
Title I of the Health Insurance Portability and Accountability Act
of 1996 (HIPAA) protects health insurance coverage for workers and
their families when they change or lose their jobs.
Do you have questions about your coverage? See how HIPAA may affect
your rights and decisions at different times.
CMS-HIPAA On-line
http://cms.hhs.gov/hipaa/online/default.asp
This interactive tool, provided by the Federal Government, helps
answer your questions about health coverage and your rights and
protections under the Health Insurance Portability and Accountability
Act (HIPAA). If you have questions on getting and continuing health
coverage during events such as losing or changing jobs, pregnancy,
moving, or divorce, you can get answers here. If you are an employer,
you can get answers to common questions about getting and renewing
group health coverage for your employees.
•
Medicaid
OBRA '89 - State by
State Impact of the OBRA 1989 EPSDT Provisions
medicaid.aphsa.org/research/epsdtissue.htm
National Association of Medicaid Directors - In 1989, the Congress
amended the Early and Periodic Screening, Diagnosis, and Treatment
(EPSDT) requirements of the Medicaid statute to provide coverage
for children of medically necessary treatment services, regardless
of whether or not the services are part of the state's benefit package,
and to impose new reporting requirements on EPSDT activities. The
OBRA 1989 Medicaid changes contributed greatly to increased state
costs for services to children. A relaxation of at least some of
the reporting requirements, plus adoption by the Department of Health
and Human Services of implementing regulations that would allow
states to manage the service requirements more effectively, could
provide welcome fiscal relief to the states. This paper presents
some more detailed information with respect to the impact of these
OBRA 89 changes. EPSTD serves children and youth to the age of 21.
SCHIP
Innovations for Children with Special Needs in Managed Care, February
2003, Fox, Limb, McManus Full Report (pdf file: 162K). Available
only on web www.chcs.org/publications/pdf/ips/schip.pdf
 This Resource
Paper provides new information about the array of SCHIP policies
and practices affecting children with special health care needs
in the 39 states that contract with managed care organizations (MCOs)
and highlights those that are most innovative. It examines state
SCHIP policies concerning covered services, MCO enrollment and benefit
responsibilities for children with special health care needs, state
policies for defining and identifying this population, and specific
contract provisions to assure the availability of specialty care.
CMS - Medicaid Infrastructure Grants -
Medicaid Buy-In
www.cms.gov/twwiia/grantuse.asp
Twenty-five (25) States were awarded Medicaid Infrastructure Grants
during this first grant cycle. All 25 of these States plan to use
a portion of their grant award in the study, implementation, or
improvement of a Medicaid Buy-in program. In addition, 19 of the
States will use a portion of their grant award to study or improve
Medicaid services designed to support the competitive employment
of persons with disabilities. In order to highlight what States
are doing with Infrastructure Grant funds in each of these two critical
areas, the following examples are provided. Lists States that have
implemented a Medicaid Buy-In.
• Privacy
- Health Records ((HIPAA
& FERPA)
PA) DOL - Health Insurance
Portability and Accountability Act (HIPAA)
www.dol.gov/pwba/newsroom/fshipaa.html
Information on HIPAA, a law that provides protections that improve
the portability and continuity of health insurance coverage and
requires that most health plans provide coverage for pre-existing
medical conditions after 12 months.
HHS - Health Insurance
Portability and Accountability Act (HIPAA)
Federal Privacy Regulations
www.hhs.gov/ocr/hipaa/assist.html
As of Monday, April 14, 2003, millions of health plans, hospitals,
doctors and other health care providers around the country must
comply with the privacy provisions of the Health Insurance Portability
and Accountability Act (HIPAA). An extensive collection of frequently
asked questions and other information about HIPAA are available
on the HHS Web site.
The Impact of FERPA
and HIPAA on Privacy Protection
for Health Information at School: Questions from Readers
www.healthinschools.org/ejournal/2003/privacy.htm
SOURCE: Health and Health Care in Schools, the Center for Health
and Health Care in Schools Supplement June 2003 Compilation of questions
the Center has received concerning the Health Insurance Portability
and Accountability Act (HIPAA) privacy regulations and the status
of student health information under the Family Educational Rights
and Privacy Act (FERPA).
*See also Tools
- Laws & Legislation
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