say plans may rely on these proposed rules until final rulemaking, at least
through 2014, except where otherwise noted.
Comments are due February 24, 2014.
summarize the existing list of HIPAA excepted benefits and describe the new
benefits added to this list. We also highlight the requirements from which
these benefits are excepted.
What are the Existing HIPAA Excepted Benefits?
portability rules, which were in place prior to the ACA, included a list of
“excepted benefits.” ERISA §733; PHSA
§9832; Code §9832. This list of excepted
benefits includes an “Overall Exception” and then specific categories of
The “Overall Exception” includes accident
insurance, disability insurance, liability and liability supplement insurance,
workers’ compensation, automobile medical payment insurance, credit-only
insurance, and on-site medical clinics.
current exceptions include:
Limited scope dental and vision
coverage either offered under a separate insurance policy or where there is a
separate election and contribution required;
Benefits for long-term care or
nursing home care;
Coverage only for specified
disease or illness, such as a cancer-only policy;
Hospital indemnity or other fixed
indemnity insurance offered under a separate policy;
Medicare supplemental health
Similar supplemental coverage
under a group health plan that is offered under a separate policy and where the
value falls below a specified amount.