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Loyalty to Company A cannot/will not be rewarded by competitor company B. Why shouldthey?

Why not? That is exactly the question the many experts and the IRDA raised a few years agowhen discussing the issue of health insurance and the transfer of credits gained in a situation

where a customer shifts from Health Insurer A to B. This intervention by the IRDA has nowresulted in happy news for customers availing health insurance, especially those who are notsatisfied with their existing insurer.

Effective 01 October 2011, Health Insurance has become portable and you are now free tomove to another provider and carry along all the credits gained for having been loyal.

To get a better perspective of the whole idea of Portability we need to explore how thingsworked before 01/10/11. Let us say you were a customer, who, had a Health Insurance policywith ABC Company, and were not satisfied with their service. You approach company XYZto transfer your policy and they would have said that you will be treated as a new

policyholder. Meaning, all the benefits you had accrued by regularly paying your premium tothe earlier insurer would stand nullified and you would need to build your loyalty fromscratch.

The IRDA defines portability as - "The right accorded to an individual health insurancepolicy holder (including family cover) to transfer the credit gained by the insured for pre-existing conditions and time bound exclusions if policy holder plans to switch from oneinsurer to another insurer or from one plan to another plan of the same insurer, provided theprevious policy has been maintained without any break."

From your perspective as a customer, you need to understand two major points from theabove definition to realize how it applies to you.

1. Pre-existing condition credit

2. Time-bound exclusions

Pre-existing condition/disease

Then- When one avails of a health insurance policy, he is not given any cover for claimsarising out of a disease/condition he/she is ailing from, on the day of taking the claim.

Nevertheless, if he/she continues as a regular premium payer for 4 years (48 months), thenthe insurance company will be bound to pay for claims arising out of the existing condition.In the past, if you shifted from one company to another, you were required to again do apremium paying term of 4 years to claim for PEDs.

Now- With portability, you can carry forward credits gained for pre-existingdisease/condition to the new insurer from day one itself.

Time Exclusions

Then- Time exclusions in a health insurance policy are certain illnesses for which no claims

will be entertained for a set period from the date of taking the policy. For example, treatmentof conditions/diseases like cataract, piles etc cannot be claimed in the first 365 days of taking

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the policy. The reason for this is that these are treatments, which can be postponed for manydays, and hence the insurance company could have individuals taking a policy just forclaiming for such treatments. Such exclusions are called One-year exclusions, Two yearexclusions and so on till four years.

Now- In case you were covered under the existing insurance policy for a period of one year,the waiting period of 30 days and first year exclusions will not apply in policy to be renewed.The two-year exclusions shall apply for a period of one more year. Pre-existing conditionexclusion shall apply for a period of three more years. Similarly will be the case with 2 year,3 year and 4 year exclusions, where the period already spent with the earlier insurer will becredited to you. This also includes the 30 day mandatory waiting period.

How do I port my health insurance?

To transfer your policy from company A to company B, you will need to approach CompanyB (new insurer). You will be asked to fill in an application for porting. Company B will then

process the application and post the request on the IRDA site within 7 days. The existinginsurer (company A) will have to furnish all the required data about the insured within 7 days, again through the IRDA website. Once satisfactory data is available, Company B willunderwrite your policy and you will be a customer of B and carry forward all benefits fromcompany A.

5 things to remember before opting for porting

1. When applying for porting, be sure that your existing policy is valid for at least 45 daysmore. Else, the application will be rejected.

2. The portability is only applicable for the sum-insured under previous policy.

3. Portability is applicable for all individual health policies. In case you are a part of afamily/group policy, you will need to migrate to an individual policy from the same insurerand then apply for portability only after 1 year.

4. Sometimes the waiting period/exclusion period for the same disease might be differentfor different insurers. Ensure that you are clear about all the terms and conditions beforeapplying.

5. Do not port for saving money on premium. With the new competitive premium regime,the differences in premium of two companies will not be very high. It is not advisable to port

just because the other company is offering a lesser premium. Port if you have a serviceproblem with existing insurer. Else, remember that all said and done, you will have to build a'new relationship" with the new service provider (Agent, claim officers, front office staff etc).And relationships take time to mature.

You have been given the power to choose your provider. Get educated and take an informeddecision. Stay healthy. Stay happy

The Health Insurance Portability and Accountability Act of 1996 (HIPAA;Pub.L. 104-

191, 110Stat.1936, enacted August 21, 1996) was enacted by theUnited States Congressand signed by PresidentBill Clintonin 1996. It was originally sponsored by Sen.Edward
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Kennedy(D-Mass.) and Sen.Nancy Kassebaum(R-Kan.). Title I of HIPAA protectshealthinsurancecoverage for workers and their families when they change or lose their jobs. Title IIof HIPAA, known as the Administrative Simplification (AS) provisions, requires theestablishment of national standards forelectronic health caretransactions and nationalidentifiers for providers, health insurance plans, and employers.[1]

The Administration Simplification provisions also address the security and privacy of healthdata. The standards are meant to improve the efficiency and effectiveness of the nation'shealth care system by encouraging the widespread use ofelectronic data interchangein theU.S. health care system.

Contents

[hide]

1 Title I: Health Care Access, Portability, and Renewability 2 Title II: Preventing Health Care Fraud and Abuse; Administrative Simplification;

Medical Liability Reformo 2.1 Privacy Ruleo 2.2 Transactions and Code Sets Ruleo 2.3 Brief 5010 Transactions and Code Sets Rules Update Summaryo 2.4 Security Ruleo 2.5 Unique Identifiers Rule (National Provider Identifier)o 2.6 Enforcement Rule

3 HITECH Act: Privacy Requirements 4 Effects on research and clinical care

o 4.1 Effects on researcho 4.2 Effects on clinical careo 4.3 Costs of implementation

5 HIPAA and drug and alcohol rehabilitation organizations 6 Notable Violations 7 Legislative information 8 References 9 External links

[edit] Title I: Health Care Access, Portability, andRenewability

Title I ofHIPAA regulates the availability and breadth of group health plans and certainindividual health insurance policies. It amended the Employee Retirement Income SecurityAct, the Public Health Service Act, and the Internal Revenue Code.

Title I also limits restrictions that a group health plan can place on benefits for preexistingconditions. Group health plans may refuse to provide benefits relating to preexistingconditions for a period of 12 months after enrollment in the plan or 18 months in the case of

late enrollment.[2]

However, individuals may reduce this exclusion period if they had grouphealth plan coverage or health insurance prior to enrolling in the plan. Title I allows
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individuals to reduce the exclusion period by the amount of time that they had "creditablecoverage" prior to enrolling in the plan and after any "significant breaks" in coverage.[3]"Creditable coverage" is defined quite broadly and includes nearly all group and individualhealth plans, Medicare, and Medicaid.[4]A "significant break" in coverage is defined as any63 day period without any creditable coverage.[5]

Some health care plans are exempted from Title I requirements, such as long-term healthplans and limited-scope plans such as dental or vision plans that are offered separately fromthe general health plan. However, if such benefits are part of the general health plan, thenHIPAA still applies to such benefits. For example, if the new plan offers dental benefits, thenit must count creditable continuous coverage under the old health plan towards any of itsexclusion periods for dental benefits.

An alternate method of calculating creditable continuous coverage is available to the healthplan under Title I. That is, 5 categories of health coverage can be considered separately,including dental and vision coverage. Anything not under those 5 categories must use the

general calculation (e.g., the beneficiary may be counted with 18 months of general coverage,but only 6 months of dental coverage, because the beneficiary did not have a general healthplan that covered dental until 6 months prior to the application date). Since limited-coverageplans are exempt from HIPAA requirements, the odd case exists in which the applicant to ageneral group health plan cannot obtain certificates of creditable continuous coverage forindependent limited-scope plans such as dental to apply towards exclusion periods of the newplan that does include those coverages.

Hidden exclusion periods are not valid under Title I (e.g., "The accident, to be covered, musthave occurred while the beneficiary was covered under this exact same health insurancecontract"). Such clauses must not be acted upon by the health plan and also must be re-written so that they comply with HIPAA.

To illustrate, suppose someone enrolls in a group health plan on January 1, 2006. This personhad previously been insured from January 1, 2004 until February 1, 2005 and from August 1,2005 until December 31, 2005. To determine how much coverage can be credited against theexclusion period in the new plan, start at the enrollment date and count backwards until youreach a significant break in coverage. So, the five months of coverage between August 1,2005 and December 31, 2005 clearly counts against the exclusion period. But the periodwithout insurance between February 1, 2005 and August 1, 2005 is greater than 63 days.Thus, this is a significant break in coverage, and any coverage prior to it cannot be deducted

from the exclusion period. So, this person could deduct five months from his or her exclusionperiod, reducing the exclusion period to seven months. Hence, Title I requires that anypreexisting condition begin to be covered on August 1.

[edit] Title II: Preventing Health Care Fraud and Abuse;

Administrative Simplification; Medical Liability Reform

This section needs additionalcitationsforverification. Please helpimprove thisarticleby adding citations toreliable sources. Unsourced material may bechallengedandremoved.(April 2010)
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Title II of HIPAA defines numerous offenses relating to health care and sets civil andcriminal penalties for them. It also creates several programs to control fraud and abuse withinthe health care system.[6][7][8]However, the most significant provisions of Title II are itsAdministrative Simplification rules. Title II requires theDepartment of Health and HumanServices(HHS) to draft rules aimed at increasing the efficiency of the health care system by

creating standards for the use and dissemination of health care information.

These rules apply to "covered entities" as defined by HIPAA and the HHS. Covered entitiesinclude health plans, health care clearinghouses, such as billing services and communityhealth information systems, and health care providers that transmit health care data in a waythat is regulated by HIPAA.[9][10]

Per the requirements of Title II, the HHS has promulgated five rules regarding AdministrativeSimplification: the Privacy Rule, the Transactions and Code Sets Rule, the Security Rule, theUnique Identifiers Rule, and the Enforcement Rule.

[edit] Privacy Rule

The effective compliance date of the Privacy Rule was April 14, 2003 with a one-yearextension for certain "small plans". The HIPAA Privacy Rule regulates the use and disclosureof Protected Health Information (PHI) held by "covered entities" (generally, health careclearinghouses, employer sponsored health plans, health insurers, and medical serviceproviders that engage in certain transactions.)[11]By regulation, the Department of Health andHuman Services extended the HIPAA privacy rule to independent contractors of coveredentities who fit within the definition of "business associates".[12]PHI is any information heldby a covered entity which concerns health status, provision of health care, or payment for

health care that can be linked to an individual.

[13]

This is interpreted rather broadly andincludes any part of an individual's medical record or payment history. Covered entities mustdisclose PHI to the individual within 30 days upon request.[14]They also must disclose PHIwhen required to do so by law, such as reporting suspectedchild abuseto state child welfareagencies.[15]

A covered entity may disclose PHI to facilitate treatment, payment, or health careoperations,[16]or if the covered entity has obtained authorization from the individual.[17]However, when a covered entity discloses any PHI, it must make a reasonable effort todisclose only the minimum necessary information required to achieve its purpose.[18]

The Privacy Rule gives individuals the right to request that a covered entity correct anyinaccurate PHI.[19]It also requires covered entities to take reasonable steps to ensure theconfidentiality of communications with individuals.[20]For example, an individual can ask tobe called at his or her work number, instead of home or cell phone number.

The Privacy Rule requires covered entities to notify individuals of uses of their PHI. Coveredentities must also keep track of disclosures of PHI and document privacy policies andprocedures.[21]They must appoint a Privacy Official and a contact person[22]responsible forreceiving complaints and train all members of their workforce in procedures regardingPHI.[23]

An individual who believes that the Privacy Rule is not being upheld can file a complaintwith theDepartment of Health and Human ServicesOffice for Civil Rights (OCR).[24][25]
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However, according to the Wall Street Journal, the OCR has a long backlog and ignores mostcomplaints. "Complaints of privacy violations have been piling up at the Department ofHealth and Human Services. Between April of 2003 and November 2006, the agency fielded23,886 complaints related to medical-privacy rules, but it has not yet taken any enforcementactions against hospitals, doctors, insurers or anyone else for rule violations. A spokesman for

the agency says it has closed three-quarters of the complaints, typically because it found noviolation or after it provided informal guidance to the parties involved."[26]However, in July2011, UCLA agreed to pay $865,500 in a settlement regarding potential HIPAA violations.An HHS Office for Civil Rights investigation showed from 2005 to 2008 unauthorizedemployees, repeatedly and without legitimate cause, looked at the electronic protected healthinformation of numerous UCLAHS patients.[27]

[edit] Transactions and Code Sets Rule

HIPAA was intended to make the health care system in the United States more efficient bystandardizing health care transactions. HIPAA added a new Part C titled "AdministrativeSimplification" to Title XI of the Social Security Act. This is supposed to simplify health caretransactions by requiring all health plans to engage in health care transactions in astandardized way.

The HIPAA/EDI provision was scheduled to take effect from October 16, 2003 with a one-year extension for certain "small plans". However, due to widespread confusion and difficultyin implementing the rule, CMS granted a one-year extension to all parties. [citation needed] OnJanuary 1, 2012 newer versions,ASC X12005010 and NCPDP D.0 become effective,replacing the previous ASC X12 004010 and NCPDP 5.1 mandate.[28]The ASC X12 005010version provides a mechanism allowing the use ofICD-10-CMas well as other

improvements.

After July 1, 2005 most medical providers that file electronically did have to file theirelectronic claims using the HIPAA standards in order to be paid.[citation needed]

Under HIPAA, HIPAA-covered health plans are now required to use standardized HIPAAelectronic transactions. See, 42 USC 1320d-2 and 45 CFR Part 162. Information about thiscan be found in the final rule for HIPAA electronic transaction standards (74 Fed. Reg. 3296,published in the Federal Register on January 16, 2009), and on the CMS website here:CMSinformation on HIPAA standardized electronic transactions

KeyEDI(X12) transactions used for HIPAA compliance are:

EDI Health Care Claim Transaction set (837) is used to submit health care claim billinginformation, encounter information, or both, except for retail pharmacy claims (see EDIRetail Pharmacy Claim Transaction). It can be sent from providers of health care services topayers, either directly or via intermediary billers and claims clearinghouses. It can also beused to transmit health care claims and billing payment information between payers withdifferent payment responsibilities where coordination of benefits is required or betweenpayers and regulatory agencies to monitor the rendering, billing, and/or payment of healthcare services within a specific health care/insurance industry segment.

For example, a state mental health agency may mandate all healthcare claims, Providers andhealth plans who trade professional (medical) health care claims electronically must use the
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or treatment data for the purpose of request for review, certification, notification or reportingthe outcome of a health care services review.

EDI Functional Acknowledgement Transaction Set (997) this transaction set can be usedto define the control structures for a set of acknowledgments to indicate the results of the

syntactical analysis of the electronically encoded documents. Although it is not specificallynamed in the HIPAA Legislation or Final Rule, it is necessary for X12 transaction setprocessing. The encoded documents are the transaction sets, which are grouped in functionalgroups, used in defining transactions for business data interchange. This standard does notcover the semantic meaning of the information encoded in the transaction sets.

[edit] Brief 5010 Transactions and Code Sets Rules Update Summary

1) Transaction Set (997) will be replaced by Transaction Set (999) "acknowledgementreport". 2) The size of many fields {segment elements} will be expanded, causing a need forall IT providers to expand corresponding fields, element, files, GUI, paper media anddatabases. 3) Some segments have been removed from existing Transaction Sets. 4) Manysegments have been added to existing Transaction Sets allowing greater tracking andreporting of cost and patient encounters. 5) Capacity to use both "International Classificationof Diseases" versions 9 (ICD-9) and 10 (ICD-10-CM) has been added.

[29]

[30]

[edit] Security Rule

The Final Rule on Security Standards was issued on February 20, 2003. It took effect onApril 21, 2003 with a compliance date of April 21, 2005 for most covered entities and April21, 2006 for "small plans". The Security Rule complements the Privacy Rule. While thePrivacy Rule pertains to all Protected Health Information (PHI) including paper andelectronic, the Security Rule deals specifically with Electronic Protected Health Information(EPHI). It lays out three types of security safeguards required for compliance: administrative,physical, and technical. For each of these types, the Rule identifies various security standards,and for each standard, it names both required and addressable implementation specifications.Required specifications must be adopted and administered as dictated by the Rule.Addressable specifications are more flexible. Individual covered entities can evaluate their

own situation and determine the best way to implement addressable specifications. Someprivacy advocates have argued that this "flexibility" may provide too much latitude tocovered entities.[31]The standards and specifications are as follows:

Administrative Safeguardspolicies and procedures designed to clearly show how theentity will comply with the acto Covered entities (entities that must comply with HIPAA requirements) must adopt a

written set of privacy procedures and designate a privacy officer to be responsible fordeveloping and implementing all required policies and procedures.

o The policies and procedures must reference management oversight and organizationalbuy-in to compliance with the documented security controls.

o Procedures should clearly identify employees or classes of employees who will haveaccess to electronic protected health information (EPHI). Access to EPHI must be
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restricted to only those employees who have a need for it to complete their jobfunction.

o The procedures must address access authorization, establishment, modification, andtermination.

o Entities must show that an appropriate ongoing training program regarding the

handling of PHI is provided to employees performing health plan administrativefunctions.

o Covered entities that out-source some of their business processes to a third party mustensure that their vendors also have a framework in place to comply with HIPAArequirements. Companies typically gain this assurance through clauses in thecontracts stating that the vendor will meet the same data protection requirements thatapply to the covered entity. Care must be taken to determine if the vendor further out-sources any data handling functions to other vendors and monitor whetherappropriate contracts and controls are in place.

o A contingency plan should be in place for responding to emergencies. Coveredentities are responsible for backing up their data and having disaster recovery

procedures in place. The plan should document data priority and failure analysis,testing activities, and change control procedures.

o Internal audits play a key role in HIPAA compliance by reviewing operations withthe goal of identifying potential security violations. Policies and procedures shouldspecifically document the scope, frequency, and procedures of audits. Audits shouldbe both routine and event-based.

o Procedures should document instructions for addressing and responding to securitybreaches that are identified either during the audit or the normal course of operations.

Physical Safeguardscontrolling physical access to protect against inappropriate accessto protected datao Controls must govern the introduction and removal of hardware and software from

the network. (When equipment is retired it must be disposed of properly to ensurethat PHI is not compromised.)

o Access to equipment containing health information should be carefully controlled andmonitored.

o Access to hardware and software must be limited to properly authorized individuals.o Required access controls consist of facility security plans, maintenance records, and

visitor sign-in and escorts.o Policies are required to address proper workstation use. Workstations should be

removed from high traffic areas and monitor screens should not be in direct view of

the public.o If the covered entities utilize contractors or agents, they too must be fully trained on

their physical access responsibilities.

Technical Safeguardscontrolling access to computer systems and enabling coveredentities to protect communications containing PHI transmitted electronically over opennetworks from being intercepted by anyone other than the intended recipient.o Information systems housing PHI must be protected from intrusion. When

information flows over open networks, some form of encryption must be utilized. Ifclosed systems/networks are utilized, existing access controls are consideredsufficient and encryption is optional.

o Each covered entity is responsible for ensuring that the data within its systems hasnot been changed or erased in an unauthorized manner.

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o Data corroboration, including the use of check sum, double-keying, messageauthentication, and digital signature may be used to ensure data integrity.

o Covered entities must also authenticate entities with which they communicate.Authentication consists of corroborating that an entity is who it claims to be.Examples of corroboration include: password systems, two or three-way handshakes,

telephone callback, and token systems.o Covered entities must make documentation of their HIPAA practices available to the

government to determine compliance.o In addition to policies and procedures and access records, information technology

documentation should also include a written record of all configuration settings onthe components of the network because these components are complex, configurable,and always changing.

o Documented risk analysis and risk management programs are required. Coveredentities must carefully consider the risks of their operations as they implementsystems to comply with the act. (The requirement of risk analysis and riskmanagement implies that the acts security requirements are a minimum standard and

places responsibility on covered entities to take all reasonable precautions necessaryto prevent PHI from being used for non-health purposes.)

[edit] Unique Identifiers Rule (National Provider Identifier)

HIPAA covered entities such as providers completing electronic transactions, healthcareclearinghouses, and large health plans, must use only the National Provider Identifier (NPI)to identify covered healthcare providers in standard transactions by May 23, 2007. Smallhealth plans must use only the NPI by May 23, 2008.

Effective from May 2006 (May 2007 for small health plans), all covered entities usingelectronic communications (e.g., physicians, hospitals, health insurance companies, and soforth) must use a single new NPI. The NPI replaces all other identifiers used by health plans,Medicare, Medicaid, and other government programs. However, the NPI does not replace aprovider's DEA number, state license number, or tax identification number. The NPI is 10digits (may be alphanumeric), with the last digit being a checksum. The NPI cannot containany embedded intelligence; in other words, the NPI is simply a number that does not itselfhave any additional meaning. The NPI is unique and national, never re-used, and except forinstitutions, a provider usually can have only one. An institution may obtain multiple NPIsfor different "subparts" such as a free-standing cancer center or rehab facility.

[edit] Enforcement Rule

On February 16, 2006, HHS issued the Final Rule regarding HIPAA enforcement. It becameeffective on March 16, 2006. The Enforcement Rule sets civil money penalties for violatingHIPAA rules and establishes procedures for investigations and hearings for HIPAAviolations; however, its deterrent effects seem to be negligible with few prosecutions forviolations.[32]

Wikisourcehas original text related to this article:American Recovery and Reinvestment Act of 2009/Division A/Title

XIII/Subtitle D
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[edit] HITECH Act: Privacy Requirements

Subtitle D of the Health Information Technology for Economic and Clinical Health Act(HITECH Act), enacted as part of theAmerican Recovery and Reinvestment Act of 2009,addresses the privacy and security concerns associated with the electronic transmission ofhealth information.

This subtitle extends the complete Privacy and Security Provisions of HIPAA to businessassociates of covered entities. This includes the extension of newly updated civil and criminalpenalties to business associates. These changes are also required to be included in anybusiness associate agreements with covered entities. On November 30, 2009, the regulationsassociated with the new enhancements to HIPAA enforcement took effect.[33]

Another significant change brought about in Subtitle D of the HITECH Act, is the newbreach notification requirements. This imposes new notification requirements on covered

entities, business associates, vendors of personal health records (PHR) and related entities if abreach of unsecured protected health information (PHI) occurs. On April 27, 2009, theDepartment of Health and Human Services (HHS) issued guidance on how to secureprotected health information appropriately.[34]Both HHS and the Federal Trade Commission(FTC) were required under the HITECH Act to issue regulations associated with the newbreach notification requirements. The HHS rule was published in the Federal Register onAugust 24, 2009,[35]and the FTC rule was published on August 25, 2009.[36]

The final significant change made in Subtitle D of the HITECH Act, implements new rulesfor the accounting of disclosures of a patient's health information. It extends the currentaccounting for disclosure requirements to information that is used to carry out treatment,

payment and health care operations when an organization is using anelectronic health record(EHR). This new requirement also limits the timeframe for the accounting to three yearsinstead of six as it currently stands. These changes won't take effect until January 1, 2011, fororganizations implementing EHRs between January 1, 2009 and January 1, 2011, andJanuary 1, 2013, for organizations who had implemented an EHR prior to January 1, 2009.

[edit] Effects on research and clinical care

The enactment of the Privacy and Security Rules has caused major changes in the wayphysicians and medical centers operate. The complex legalities and potentially stiff penalties

associated with HIPAA, as well as the increase in paperwork and the cost of itsimplementation, were causes for concern among physicians and medical centers. An August2006 article in the journalAnnals of Internal Medicine detailed some such concerns over theimplementation and effects of HIPAA.[37]

[edit] Effects on research

HIPAA restrictions on researchers have affected their ability to perform retrospective, chart-based research as well as their ability to prospectively evaluate patients by contacting themfor follow-up. A study from theUniversity of Michigandemonstrated that implementation ofthe HIPAA Privacy rule resulted in a drop from 96% to 34% in the proportion of follow-up

surveys completed by study patients being followed after aheart attack.[38]Another study,detailing the effects of HIPAA on recruitment for a study on cancer prevention, demonstrated
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that HIPAA-mandated changes led to a 73% decrease in patient accrual, a tripling of timespent recruiting patients, and a tripling of mean recruitment costs.[39]

In addition,informed consentforms for research studies now are required to includeextensive detail on how the participant's protected health information will be kept private.

While such information is important, the addition of a lengthy, legalistic section on privacymay make these already complex documents even less user-friendly for patients who areasked to read and sign them.

These data suggest that the HIPAA privacy rule, as currently implemented, may be havingnegative impacts on the cost and quality of medical research. Dr. Kim Eagle, professor ofinternal medicineat the University of Michigan, was quoted in theAnnals article as saying,"Privacy is important, but research is also important for improving care. We hope that we willfigure this out and do it right."[37]

[edit] Effects on clinical care

The complexity of HIPAA, combined with potentially stiff penalties for violators, can leadphysicians and medical centers to withhold information from those who may have a right toit. A review of the implementation of the HIPAA Privacy Rule by the U.S. GovernmentAccountability Office found that health care providers were "uncertain about their legalprivacy responsibilities and often responded with an overly guarded approach to disclosinginformation...than necessary to ensure compliance with the Privacy rule".[37]Reports of thisuncertainty continue.[40]

[edit] Costs of implementation

In the period immediately prior to the enactment of the HIPAA Privacy and Security Acts,medical centers and medical practices were charged with getting "into compliance". With anearly emphasis on the potentially severe penalties associated with violation, many practicesand centers turned to private, for-profit "HIPAA consultants" who were intimately familiarwith the details of the legislation and offered their services to ensure that physicians andmedical centers were fully "in compliance". In addition to the costs of developing andrevamping systems and practices, the increase in paperwork and staff time necessary to meetthe legal requirements of HIPAA may impact the finances of medical centers and practices ata time when insurance companies and Medicare reimbursement is also declining.

Health insurance consumers will be able to change their service providers from Monday, as the insurers are finally ready withthe long-awaited portability norm.

However, health insurance portability will be limited to non-life insurers, which will allow policy switch with respect to allindividual policies, including family floater policies.

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1-Irda postpones health insurance
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portability

-Irda defers launch of healthinsurance portability to Oct 1

-Extend health insurance portabilityto group medical policies: Study

-New insurer, same cover

-Subir Roy: Pre-payment penaltyshould go forthwith

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More

Even individual members, including the family members covered under group health insurance policy of a non-life insurer, willbe able to migrate from a group health policy to an individual policy or a family floater with the same insurer.

The scheme was proposed to come into force from July 1, but was deferred by three months due to certain outstanding issueswith insurance companies.

According to the new guidelines, consumers will get credit for the time already spent for covering pre-existing diseases, alongwith bonus accrued to them from their past insurers.

Policyholders, however, will be able to carry over the waiting period with respect to pre-existing ailments. The waiting period formost pre-existing conditions is four years. For instance, if a person wants to shift after a year itself, the waiting period for thepre-existing ailment will be three years with the new insurer.

Health insurance portability has come in after a long wait. First lets see what it means before we delve

into whom it will benefit and how.

What it means

Shyamal Banerjee/Mint

Mobile number portability means that you can keep

the same mobile number even as you switch the

service provider. In health insurance it means that

the period of time that you spend with your existing

health insurance provider will be taken into account

while working out the period of exclusions such as

reimbursement of hospitalization expenses coming

from pre-existing diseases or other temporary

exclusions. For example, if the new health

insurance company has a clause that they will not

cover hospitalization expenses of knee replacementsurgery within the first two years of the policy and you have had a policy for three years with your

existing insurance company, then the new health insurance company will cover knee replacement
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surgery expenses from the very first year of the policy with them. A pleasant surprise has been the right

provided to the insured persons in group insurance policy to shift to an individual plan with the same

insurance company that provided the group insurance policy.

What it does not mean

Just like mobile number portability, health insurance portability ensures that you have the option to shift

to a new insurer with the same policy but it does not compel the new insurer to offer you the service. So

if the new insurer refuses to provide the service, you will need to look at another provider or give up the

idea of changing your service provider. Similarly, for health insurance, if you are already suffering from

a serious disease, you are likely to find that portability is only a theoretical option as no other health

insurance provider is willing to offer you its insurance policy.

However, if you are part of a group insurance plan then the same insurance company cannot deny you

the right to buy an individual plan from them.

Who will benefit?

The biggest beneficiaries of this will be employees who are falling out of a group insurance plan either

due to retirement or resignation from a company. A lot of group insurance plans allow coverage of the

parents of the employees, who otherwise find it difficult to get an insurance policy on their own. Retired

employees also find it difficult to get a good health insurance plan. Now such employees can get a family

floater plan from the same insurance company which cannot be refused.

The other big beneficiaries will be young insured persons, who are healthy but are stuck with high-cost

policies (think of companies which hiked premiums by 500% last year) or sub-optimal policies (which

have very low sub-limits for room rents or other expenditure or require you to meet a large part of the

eligible hospitalization expenditure yourselfcalled co-payment in insurance parlance). They can now

shift to better policies that have no such restrictions and are reasonably priced.

How will you benefit?

Retiring people should make this application at least 60 days (the requirement is 45 days but it is better

to be safe than be sorry) before their retirement date. Similarly, employees who are resigning need to

make this application at least 45 days before they lose membership from the group plan due to the

resignation (for resigning employees this has implications in terms of how soon will they let their

employers know about their moving and whether their employer will give them the benefit of 45 days

notice period). Regular consumers wishing to switch insurers should in any case make this application

well in time before their existing policies expire.

In all cases, consumers will need to submit the regular proposal form of the insurance company along

with a portability form that is available atwww.irda.gov.in/ADMINCMS/cms/Search_Results.aspx

Please fully disclose all material facts that are relevant to the policy including any disease or claims

made by you. This may result in the premium being higher or even the policy being denied. But it is far

better to have an expensive policy or a policy that will actually pay the claim then to have a cheap policy

where the claim is not paid.

Who may not benefit

When portability was thought about, the immediate beneficiary that came to our mind was the person

who had a bad experience while getting his claim settled. Unfortunately, those consumers are unlikely to

be welcomed by the new insurance company.

The only saving grace here is the unexpected procedural benefit provided by the Insurance Regulatoryand Development Authority (Irda), wherein the refusal has to be conveyed by the insurance company in

writing within 15 days of receiving the proposal and all documents and information relating to the
http://www.irda.gov.in/ADMINCMS/cms/Search_Results.aspxhttp://www.irda.gov.in/ADMINCMS/cms/Search_Results.aspxhttp://www.irda.gov.in/ADMINCMS/cms/Search_Results.aspxhttp://www.irda.gov.in/ADMINCMS/cms/Search_Results.aspx

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portability proposal. So if you apply to any insurance company for portability plus an enhanced sum

assured, then the company will need to respond back in writing or they will lose the right of refusal. In

short, insurance companies will no longer be able to use inaction as a way to conveniently avoid taking

on what they consider high-risk consumers.

Unexpected effect

Portability from group insurance policies was not envisaged when the subject was first being debated.

Ironically, this benefit will ensure that group insurance policies will now be priced much higher and

benefit for parents of employees are likely to be withdrawn or made prohibitively expensive since the

company cannot refuse to issue an individual policy to the same family.

Harsh Roongta is CEO, Apnapaisa.com.

We welcome your comments at [email protected]

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