The HIPAA health insurance reform requirements apply to group health plans, as well as the Newborns' and Mothers' Health Protection Act, and the Women's Health and Cancer Rights Act. The Mental Health Parity Act applies to group health plans of large employers, but does not apply to group health plans of small employers or individual market (non-employment based) policies.

A large employer is an organization (or a non federal governmental employer) that has at least 51 employees.  (Certain HIPAA requirements only apply to large employers.)  A small employer is a company (or a non federal governmental employer) that has at least two but not more than 50 employees. Some states, however, may consider a business with only one employee a small employer.  An individual market policy is a non-employment based policy.

Contact your state department of insurance, if you sponsor a fully insured plan, to find out whether there are any additional requirements.

In general, non federal governmental group health plans are subject to the requirements mentioned above to the same extent as other employer group health plans. However, a non federal governmental employer that provides self-funded group health coverage to its employees may elect to exempt its plan from certain requirements of title XXVII of the Public Health Service (PHS) Act.

In addition to having to comply with certain requirements under HIPAA, employers sponsoring group health plans also enjoy certain protections under HIPAA. For example, a group health insurance issuer generally is required to sell coverage to all small employers. Also, a group health insurance issuer generally is required to renew coverage to all employers.

For additional information, you may e-mail us at phig@cms.hhs.gov.

Note:  A non federal government employer that provides self-funded group health plan coverage to its employees (coverage that is not provided through an insurer) may elect to exempt its plan (opt-out) from most requirements of title XXVII of the Public Health Service (PHS) Act, with the exception of requirements pertaining to the certification and disclosure of an individual's creditable coverage under the plan.

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Page Last Modified: 07/23/2008 3:10:54 PM
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