Blue Access for Producers

Updated HIPAA Rules Impact BCBSTX Employer Groups

Effective February 28, 2005, the U.S. Departments of Labor, Treasury, and Health and Human Services issued final regulations regarding the portability provisions of the Health Insurance Portability and Accountability Act (HIPAA).

The new regulations became effective for group health insurance plans on their plan year anniversaries beginning July 1, and after, and continuing through June 2006 plan year anniversary dates.

The new federal rules do not significantly change the framework of the 1997 interim regulations. Employer accounts will receive special information and new General Rights notices in their HCSC annual renewal packets.

Here are a few highlights of the new HIPAA rules effective upon groups' next plan year anniversary date:

  • Foreign health care coverage is now allowed as creditable coverage.
  • Special enrollment events allow an off-cycle benefit change if applicable. Group plans have multiple choices, such as Health Maintenance Organization (HMO) to Preferred Provider Health Insurance Plan (PPO), or PPO High to PPO Low.
  • Certificates of creditable coverage will be generated if maximum benefits are exceeded, even if the coverage remains in force.
  • Prescription medicine taken during a pre-existing look-back period constitutes receiving treatment.

Groups were notified before July 1 through a mass e-mail/fax message to request a written reply if their plan year is different from their Blue Cross and Blue Shield of Texas (BCBSTX) anniversary date. Groups have 30 days to respond if the new HIPAA changes need to take effect on a date other than the BCBSTX anniversary date.

Groups will receive more information upon their plan anniversary dates.