HIPAA (Health Insurance Portability and Accountability Act)

Family coverage is defined as the contract holder and his or her dependents. Dependents include a spouse and unmarried dependent children including legally adopted children, step-children and children of a domestic partner if the child depends on the contract holder for his or her support. Some states also include unmarried domestic partners under the definition of family.

HIPAA established national standards for the portability of insurance and set security standards for electronic health care information. HIPAA regulates the availability and breadth of group and individual health insurance plans, amending both the Employee Retirement Income Security Act and the Public Health Service Act. HIPAA prohibits any group health plan from creating eligibility rules or assessing premiums for individuals in the plan based on health status, medical history, genetic information or disability. It does not apply to private individual insurance. It also limits restrictions that a group health plan can place on benefits for preexisting conditions. HIPAA also includes rules aimed at increasing the efficiency of the health care system by creating standards for the use and dissemination of health care information. The final rule adopting HIPAA standards for security was published in the Federal Register on February 20, 2003. This rule specifies a series of administrative, technical, and physical security procedures for covered entities to use to assure the confidentiality of electronic protected health information.

 

 

Primary Care Physician 

 

Under managed care plans such as HMOs or POS plans, the first contact for health care is the primary care physician—often a family doctor, internist or pediatrician. A primary care physician monitors your health and treats most basic health problems. In many plans, the insured must have a referral from the primary care doctor in order to receive covered care from a specialist.

 

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