Month: January 2005

SEAK, Inc. has announced a new publication–The Biggest Legal Mistakes Physicians Make and How to Avoid Them–authored by various attorneys around the country. Included in the 640 page publication is a chapter on ERISA which I authored. You can access the Table of Contents here.

SEAK, Inc., founded in 1980, provides customized training, seminars, publications, and professional directories for expert witnesses of all disciplines, physicians, attorneys, independent medical examiners, and workers’ compensation professionals.

At the end of last year, the Department of Health and Human Services (HHS), EBSA , and the IRS issued new rules pertaining to HIPAA:

• Final Regulations for Health Coverage Portability
• Proposed Regulations for Health Coverage Portability for Group Health Plans and Group Health Insurance Issuers Under HIPAA Titles I & IV
• Request for Comments on Benefit-Specific Waiting Periods Under HIPAA Titles I & IV

(Links via Benefitslink.com).

The HHS press release states that the final regulations will accomplish the following:

• Requires group health plans and group health insurance issuers to include, concurrently with the certificate of creditable coverage provided to individuals when they lose coverage under the plan, an educational statement on their HIPAA rights.
• Includes model language that group health plans and group health insurance issuers can use for the new educational statement.
• Recognizes health plans maintained by foreign governments, and by the U.S. government (such as Veterans Administration coverage) as creditable coverage that can be used to reduce the length of or eliminate a preexisting condition exclusion.
• Offers sample language that plans and issuers can use to satisfy their obligations to provide participants notices of preexisting condition exclusions.
• Clarifies that certain plan benefit restrictions are in fact preexisting condition exclusions that must comply with HIPAA’s limitations on such exclusions.

The proposed regulations contain the following changes:

• Would provide an extension of time for individuals to exercise certain HIPAA portability rights, in situations where the individual must exercise those rights within a certain number of days after losing coverage, but the individual is not promptly notified through a certificate of creditable coverage that he or she has lost coverage.
• Would specify that group health plans and group health insurance issuers must provide a certificate of creditable coverage when an individual leaves a group health plan while taking leave under the Family and Medical Leave Act, and that any period of time during which a person does not have coverage while under such leave does not count against him with regard to HIPAA’s protections.
• Would set forth a mathematical formula for counting the average number of employees employed by an employer during a year (various HIPAA health insurance reform provisions require the determination of such an average number).

The regulations mention that HHS has a HIPAA website, but the website doesn’t appear to be updated yet with the changes.