HIPAA Nondiscrimination Rules

The Health Insurance Portability and Accountability Act (HIPAA) prohibits group health plans and group health insurance issuers from discriminating against individuals with regard to eligibility, premiums or coverage based upon a health status-related factor.

The Health Insurance Portability and Accountability Act (HIPAA) prohibits group health plans and group health insurance issuers from discriminating against individuals with regard to eligibility, premiums or coverage based upon a health status-related factor.

For example, under HIPAA, employers cannot:

Require an individual to pass a physical examination in order to be eligible to enroll in health plan coverage;

Exclude individuals from coverage because they participate in dangerous activities or have high health claims;

Charge an individual within a group of similarly situated individuals a different premium rate based upon that individual’s health factors; or

Delay enrollment in the health plan until an employee is actively at work (unless individuals who are absent from work due to any health factor are treated as if they are actively at work).