The final rule implementing the provisions under the Health Insurance Portability and Accountability Act of 1996 that prohibit discrimination based on a health factor for group health plans and insurers adopts the 2001 interim nondiscrimination rules and proposed rules on wellness programs.
The 2001 interim rule prohibited group health plans from charging similarly situated individuals different premiums or contributions or imposing different deductible, copayment, or other cost sharing requirements based on a health factor. The final nondiscrimination rules, however, do not apply to certain wellness programs, which establish discounts or modify deductibles or copayments in return for adherence to programs of health promotion or disease prevention.
The final rule clarifies how the source-of-injury rules apply to the timing of a diagnosis of a medical condition and add an example to illustrate how the benefits rules apply to the carryover feature of health reimbursement arrangements. For wellness programs, the final rule clarifies ambiguities in the proposed rule. The final rule does not republish the expired transitional rules regarding individuals that were denied coverage based on a health factor prior to the applicability date of the 2001 interim final rule.
Source: Final rule, 71 FR 75014, Dec. 13, 2006.
For more information on this and related topics, consult the CCH® Medicare and Medicaid Guide..
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