HIPAA - Pennsylvania

Summary of differences between federal and state regulations

Federal HIPAA portability provisions limit exclusions for preexisting conditions; prohibit discrimination against employees and dependents based on their health status; and allow a special opportunity to enroll in a new plan to individuals in certain circumstances.

States are allowed to go beyond the federal requirements. Pennsylvania maintained sovereignty over the regulation of health insurance in the Commonwealth by passing the Pennsylvania Health Care Insurance Portability Act, Act No. 29 of 1997, which adopted most of the provisions of HIPAA. Under Pennsylvania law, the period of any preexisting condition exclusion is reduced by the aggregate of the periods of creditable coverage. The state Act also requires waiting periods be applied uniformly without regard to the health status of potential plan participants. Subject to certain requirements, each health insurance issuer that offers insurance coverage in the small group market in Pennsylvania must accept every small employer in the state that applies for such coverage, and accept for enrollment under such coverage every eligible individual who applies for enrollment during the period in which the individual first becomes eligible to enroll under the terms of the group health plan.

Pennsylvania Code has health information privacy provisions for licensees. (Title 31, Chapter 146b)

State

Contact

Pennsylvania Insurance Department

Regulations

Pennsylvania Statutes
Title 40 Insurance

Pennsylvania Code
Title 31 Insurance

Chapter 146b Privacy of Consumer Health Information

Federal

Contact

Centers for Medicare & Medicaid Services

Regulations

45 CFR Parts 160 - 164

29 CFR 2590.701-1 et seq.

29 USC chapter 18, §1181