Federal & State Regulations | HIPAA - Tennessee | J. J. Keller® Compliance Network

State Info

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. Tennessee law is similar to federal and contains the following provisions:

A group health plan may impose preexisting condition exclusions only if it relates to a medical condition for which medical care, advice, diagnosis or treatment were received within the six month period ending on the enrollment date. The exclusion is for a period of not more than 12 months, 18 for late enrollees, after the enrollment date.

A period of creditable coverage won’t be counted if there was a 63-day period during all of which the individual was not covered under any creditable coverage.

An HMO which does not impose any preexisting condition exclusion with respect to any particular coverage option may impose an affiliation period for such coverage option, but only if:

such period is applied uniformly without regard to any health status-related factors
such period does not exceed two months, three in the case of a late enrollee. 56-7-2803

A group health plan may not establish rules for eligibility or continuing eligibility based on certain health-related factors including health status, medical condition, claims experience, receipt of health care, medical history, genetic information, evidence of insurability, or disability. 56-7-2804

A group health plan may not require any individual, as a condition of enrollment or continued enrollment, to pay a premium which is greater than that for a similarly situated individual enrolled in the plan, on the basis of any health-related factor of the employee or his or her dependent under the plan. 56-7-2804