Search form

Final Regulations on HIPAA Portability for Group Health Plans Contain Few Changes

By Joseph J. Lazzarotti
  • February 15, 2005

On December 30, 2004, the Departments of Treasury, Labor, and Health and Human Services published the final regulations regarding health coverage portability requirements under the Health Insurance Portability and Accountability Act of 1996. These final regulations replace the interim final regulations issued on April 1, 1997, and later clarified on December 29, 1997. The final regulations clarify some issues relating to health coverage portability, such as applying preexisting condition exclusions and counting creditable coverage. They also provide sample and model language to satisfy certain notice requirements. However, they do not fundamentally change the regime put in place by the April 1997 interim rules.

Application Date: The final regulations apply to group health plans for plan years beginning on or after July 1, 2005. Thus, for a plan with a calendar year as its plan year, the final regulations apply as of January 1, 2006.

The final regulations include clarifications to some provisions of the interim rules, including:

  • Revision, addition and restructuring of certain defined terms. For example, the final regulations add a definition for "dependent" and clarify that if an individual receiving benefits under a plan changes benefit package options, or if the plan changes group health insurance issuers, the individual's enrollment date remains the same.
  • Clarification and sample/model language for certain notice requirements, including a revised model Certificate of Creditable Coverage, which will now include an "education statement" describing a participant's rights under HIPAA portability provisions.
  • Clarification of the rules regarding the issuance of Certificates of Creditable Coverage and special enrollment periods with respect to loss of eligibility, lifetime benefit limits and other issues.

Along with the final regulations, the Departments also issued proposed regulations dealing with certain other HIPAA issues. For example, the proposed regulations would toll the period during which a significant break in coverage has occurred and where a Certificate of Creditable Coverage is not provided on or before the date coverage ceases. Also, the pro-posed regulations provide guidance regarding the interaction of the HIPAA portability rules with the federal Family and Medical Leave Act.

The Jackson Lewis Benefits Group is preparing amore detailed analysis of the rules and which will be available at

In the meantime, if you have any specific questions regarding the HIPAA rules and requirements, how they may affect your group health plan, or other employee benefits issues, please contact the Jackson Lewis attorney with whom you regularly work, or Joseph Lazzarotti.

©2005 Jackson Lewis P.C. This material is provided for informational purposes only. It is not intended to constitute legal advice nor does it create a client-lawyer relationship between Jackson Lewis and any recipient. Recipients should consult with counsel before taking any actions based on the information contained within this material. This material may be considered attorney advertising in some jurisdictions. Prior results do not guarantee a similar outcome.

Reproduction of this material in whole or in part is prohibited without the express prior written consent of Jackson Lewis P.C., a law firm that built its reputation on providing workplace law representation to management. Founded in 1958, the firm has grown to more than 900 attorneys in major cities nationwide serving clients across a wide range of practices and industries including government relations, healthcare and sports law. More information about Jackson Lewis can be found at

See AllRelated Articles You May Like

July 10, 2019

2019: The Mid-Year Outlook for Employers

July 10, 2019

The first six months of 2019 have proven to be busy, challenging professionals in the labor and employment communities to keep up with a number of newly enacted laws and regulations. In the 2019: Mid-Year Outlook for Employers, Jackson Lewis attorneys provide a snapshot of activity from the first half of the year as well as a preview of... Read More

May 15, 2019

EPLI Trends, Sexual Harassment Claims, and Planning for 2019

May 15, 2019

As workplace laws continue to evolve, the potential risk exposure is increasing. Jackson Lewis prepared this trends overview to help assess the current workplace law landscape in the #MeToo era and the wave of agency charges, latest claims, and new laws.  Highlights include: Pay Equity Lawsuits: The Next Wave of Litigation... Read More

January 24, 2019

IRS Notice 2019-9 Provides Interim Guidance for Tax-Exempt Organizations Paying Excess Executive Compensation

January 24, 2019

The IRS has released a technical interim guidance on Section 4960, which was added to the Internal Revenue Code of 1986, as amended, as part of the Tax Cuts and Jobs Act. Very generally, Section 4960 imposes an excise tax in an amount equal to the corporate tax rate (currently, 21 percent) on that portion of a covered employee’s pay that... Read More

Related Practices