Wisconsin Health Insurance HIPAA & Insurance Laws Guide

Guide for Insurance Consumers Regarding the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and Wisconsin Insurance Laws

Introduction

In the past few years, both the federal government and the state of Wisconsin have enacted important protections for insurance consumers. One of the most important of these protections for health insurance consumers is the federal HIPAA law and the corresponding state legislation. This booklet provides an overview of the federal HIPAA provisions and the corresponding requirements under Wisconsin insurance law.

What Is HIPAA?

HIPAA stands for the Health Insurance Portability and Accountability Act of 1996. It seeks to address and standardize a broad range of activities by health insurance companies and health care providers. HIPAA includes five specific provisions, or titles. They are:

• Title I - Health care access, portability, and renewability
• Title II - Preventing health care fraud and abuse, administrative simplification, and medical liability reform
• Title III - Tax-related health provisions
• Title IV - Application and enforcement of group health plan requirements
• Title V - Revenue offset provisions

The intent of the federal HIPAA laws and corresponding Wisconsin legislation is to decrease the cost of health care and protect the privacy of personal health information. This booklet addresses only the requirements under Titles I and II of HIPAA and corresponding Wisconsin insurance law.

What HIPAA Does Not Provide

• HIPAA does not address the issue of the cost of insurance coverage.
• HIPAA does not require that your employer offer health insurance to its employees.
• HIPAA does not require that your employer offer comparable coverage to the coverage you had in the past.

Who Is Affected?

HIPAA applies to health plans and health care providers. Health plans include plans offered by insurance companies, health maintenance organizations (HMOs), and limited service health organizations.