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Insurance coverage 101: The whole lot You Needed to Know About HIPAA However Had been Afraid to Ask


This put up is a part of a sequence sponsored by AgentSync.

The Well being Insurance coverage Portability and Accountability Act of 1996 (HIPAA) could also be one of the crucial generally referenced medical health insurance legal guidelines, not simply by insurance coverage professionals, however within the on a regular basis lives of most Individuals. Study a bit extra about what it’s, what it does (and doesn’t do), and the way it impacts the insurance coverage trade.

Please learn our discover of privateness practices

Fast! Title a healthcare regulation that everybody is aware of of, however nobody actually is aware of. Should you guessed HIPAA, congratulations, you win! For on a regular basis residents, HIPAA references pop up at each physician’s workplace go to and, extra not too long ago, if a enterprise dares to require proof of COVID-19 vaccine standing for entry or service. Extra on that later, however spoiler alert: A enterprise requiring proof of vaccination to enter, or present providers, doesn’t violate HIPAA.

You’d be exhausting pressed to seek out an American grownup who hasn’t heard of HIPAA, or who doesn’t understand it has one thing to do with medical privateness. However the collective information of this 500-page healthcare regulation ends there. And for most individuals, that’s OK. However if you happen to work in insurance coverage, you could be one of many few who actually wants to grasp HIPAA extra than simply superficially. Then once more, HIPAA is so particular to medical health insurance and well being data that it doesn’t apply universally throughout the insurance coverage world, both.

What’s HIPAA?

Actually, it’s the Well being Insurance coverage Portability and Accountability Act of 1996. This regulation, signed in 1996 by President Clinton, was the primary regulation to handle the privateness of well being and healthcare data. Even if digital medical data barely existed in 1996, HIPAA was forward-thinking and included references to digitization within the medical and medical health insurance discipline that wouldn’t come for years.

HIPAA gave U.S. residents the suitable to anticipate some extent of privateness surrounding that data, significantly in terms of medical health insurance. It additionally gave us the suitable to entry our non-public well being data, even when that’s simpler mentioned than accomplished more often than not.

A big a part of your entire HIPAA regulation is what’s referred to as the HIPAA Privateness Rule. Based on the CDC’s web site, “The Privateness Rule requirements tackle the use and disclosure of people’ well being data (referred to as “protected well being data”) by entities topic to the Privateness Rule. These people and organizations are known as “coated entities.” The Privateness Rule additionally accommodates requirements for people’ rights to grasp and management how their well being data is used.”

In plain English:

  • Your private well being data is taken into account non-public, and thus “protected” by the regulation.
  • Sure entities (physician’s places of work, hospitals, and medical health insurance firms, amongst others) are topic to the Privateness Rule.
  • You even have the suitable to grasp and management how your protected well being data is used, together with who it’s shared with.

What does HIPAA do?

Merely put, HIPAA required the creation of nationwide requirements to guard delicate affected person well being data from being disclosed with out the affected person’s consent or information. The regulation gave duty for enforcement to the Division of Well being and Human Providers (HHS)’s Workplace for Civil Rights.

HIPAA additionally laid out legitimate causes for when protected well being data utilized by any coated entity could also be shared or disclosed. The ultimate regulation was over 500 pages, so that is clearly, and essentially, a really abridged model of the regulation! Should you’re an even bigger insurance coverage nerd than we’re, you’re welcome to learn the complete textual content of the regulation right here!

Additionally, if HIPAA is central or tangential to your work, bear in mind it is a condensed overview, not authorized steerage or due diligence. Should you want authorized recommendation, seek the advice of an legal professional.

What does HIPAA not do?

The brief reply is, “rather a lot.” As you’ve discovered by now, HIPAA applies to a really particular set of coated entities. A restaurant or bar just isn’t a coated entity. An airline just isn’t a coated entity. Thus, non-public companies that ask patrons to reveal their COVID-19 vaccination standing to be able to enter or to be served aren’t topic to HIPAA and aren’t in violation of it.

As well as HIPAA additionally doesn’t cowl:

Who’s required to observe HIPAA?

HIPAA created normal definitions for varieties of companies and entities which can be topic to its privateness rule. These embody:

  • Healthcare suppliers
  • Well being plans (together with Medicare, Medicaid, long-term care, and others–with a number of exceptions)
  • Healthcare clearinghouses
  • Enterprise associates (outlined as an individual or group apart from an worker of a coated entity who’s utilizing protected well being data to carry out providers for a coated entity)

That’s mainly it. So once more, your uncle just isn’t topic to HIPAA at a household dinner. Your neighbor’s bar or restaurant can also be not topic to HIPAA. Your native grocery retailer, movie show, and place of employment (most definitely!) aren’t topic to HIPAA.

If, and provided that, you’re one of many above entities or a “enterprise affiliate” of 1, are you and your organization required to adjust to HIPAA.

Why is HIPAA vital?

Affected person privateness is one thing most of us would agree is a vital proper. Previous to 1996, nevertheless, this wasn’t essentially the case. It definitely wasn’t assured or legally enforced.

Why HIPAA is vital for the healthcare and medical health insurance trade

Despite the fact that 1996 is hardly what we consider as “the digital age” nowadays, HIPAA was actually forward-thinking for its time. It launched some crucial ideas that will be key because the trade moved from paper data to digital well being data.

HIPAA standardized how well being knowledge should be collected and guarded, and enforced a nationally acknowledged set of codes and identifiers. Very like the transfer to structured knowledge in different industries, HIPAA necessities assisted the healthcare trade in transferring towards a digital future the place well being data is shared between sufferers, docs, clinics, insurance coverage firms, and different entities each day with an emphasis on privateness.

Why HIPAA is vital for sufferers

For sufferers, HIPAA is especially important. All of the extra in order medical data have moved into the digital age, making them topic to data safety breaches. Previous to the enactment of HIPAA, it’s doubtless that “coated entities” weren’t usually deliberately exposing private affected person data in unscrupulous methods, however there was no assure (nor had been there government-enforced penalties).

HIPAA was the primary regulation of its sort to create guidelines surrounding the storage and sharing of private well being data. It mandated a strict normal of knowledge safety controls for any organizations coping with such data. Plus, with legal guidelines in place, there are precise penalties for noncompliance.

HIPAA additionally empowered sufferers to take extra management over their healthcare by permitting them to entry their data for the aim of being extra knowledgeable about diagnoses and coverings, looking for extra medical enter from completely different suppliers, and even checking their data for errors. Earlier than HIPAA, healthcare organizations and medical health insurance firms weren’t required to adjust to any affected person’s request to entry their very own medical data.

How does HIPAA influence the insurance coverage trade?

For a lot of property and casualty insurance coverage carriers, brokers, brokers, and different insurance coverage companies, it actually doesn’t. For the overwhelming majority of the insurance coverage trade – those that don’t take care of life, well being, accident, incapacity, or associated merchandise – HIPAA doesn’t apply.

For these producers who’re dually licensed, for insurance coverage carriers that deal in well being and life, and for any insurance coverage professionals who come into contact with protected well being data in the midst of doing enterprise, HIPAA is a priority and a regulation that requires compliance.

HIPAA can even influence employers who sponsor medical health insurance protection for his or her workers. This implies it’s one thing worker profit brokers have to additionally take note of and alert their purchasers about.

Within the quarter century since HIPAA was first signed into regulation, it’s turn into a reasonably family title (as healthcare legal guidelines go!) however that doesn’t imply it’s easy or simple to grasp. Should you’re within the medical health insurance enterprise, HIPAA is only one of many insurance coverage trade rules it’s a must to take note of and make sure to adjust to. And it is best to get knowledgeable counsel in doing so.

Whereas AgentSync can’t enable you to there, we will positively hold compliance on observe on your non-HIPAA wants, resembling producer onboarding and lifecycle administration. See AgentSync in motion in the present day.



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