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HIPAA

HIPAA

Nondiscrimination Rules: Workplace Wellness Incentives

Security Risk Assessment Tool

Special Enrollment Rights

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Maximum Rewards

HIPAA does not impose a maximum reward on participatory wellness programs.
For health-contingent wellness programs, the maximum reward is 30 percent of the cost of health coverage.
For health-contingent wellness programs that are designed to prevent or reduce tobacco use, the maximum reward is 50 percent of the cost of health coverage.

ADA Limits

The ADA is another federal law that limits the maximum reward under wellness programs.
The ADA’s limits are similar (but not identical) to the limits imposed under HIPAA.

HIPAA Nondiscrimination Rules - Workplace Wellness Incentives

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Risk Assessment

Covered entities and business associates must analyze the potential risks and vulnerabilities of their ePHI.
Based on this analysis, covered entities and business associates must implement reasonable and appropriate safeguards.
Risk assessment is an ongoing process.

SRA Tool

The SRA Tool can help guide a covered entity through the risk assessment process.
It can be downloaded and run on various environments, including Windows’ and Apple’s operating systems.
The tool merely collects data; it does not send data anywhere else.

Click Here to Access the Tool

HIPAA Security Risk Assessment Tool

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Affected Health Plans

Both self-insured and fully insured plans must provide special enrollment rights.
Certain categories of coverage are exempt from HIPAA’s special enrollment rules, such as limited-scope vision and dental benefits.
Retiree-only plans are also exempt.

Special Enrollment Rights

HIPAA allows eligible individuals to enroll in health plan coverage outside of the regular enrollment periods.
These special enrollment rights apply to employees and their dependents, depending on the circumstance.
Most employers allow employees to change their pre-tax benefit elections when they experience a special enrollment event.

HIPAA Special Enrollment Rights

Compliance Reviews: Audit Protocol

Privacy Rule

Privacy, Security, and Electronic Data Interchange

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HIPAA Audit Program

The second phase of the HIPAA audit program is underway.
Covered entities and business associates may be selected for a HIPAA audit.
OCR published a protocol that describes its standards for HIPAA audits.

HIPAA Self-Audits

To prepare for a possible audit, health plan sponsors and business associates should self-audit their compliance with the HIPAA rules.
OCR’s audit protocol can be used as a guide for self-audits of HIPAA compliance.
The SRA Tool can also be used to perform and document an entity’s security risk analysis.

HIPAA Compliance Review Audit Protocol

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Affected Entities

The HIPAA Privacy Rule applies to covered entities and business associates.
A covered entity is a health plan, a health care clearinghouse or a health care provider that conducts certain transactions electronically.
In general, a business associate is an entity that performs a function, activity or specific service for a covered entity that involves PHI.

Impact on Employers

The extent of a plan sponsor’s obligations under the Privacy Rule depends on whether the employer has access to PHI for plan administration.
Sponsors of fully insured plans that do not have access to PHI have minimal obligations under the Privacy Rule.

HIPAA Privacy Rule

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HIPAA Rules

The Privacy and Security Rules establish national standards to protect individuals’ personal health information.
The EDI Rule is intended to streamline electronic health care transactions by requiring that covered entities keep and exchange information in a uniform format.

Affected Entities

The HIPAA Rules apply to covered entities and business associates.
A “covered entity” is a health plan, a health care clearinghouse or a health care provider that conducts certain transactions electronically.
In general, a business associate is an entity that performs a function, activity or specific service for a covered entity that involves PHI.

HIPAA Rules Privacy Security and EDI

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Sample Handbook Language

HR QA HIPAA Notification Requirements

Special Enrollment Notice Required by HIPAA

HIPAA Privacy and Security Overview Presentation

CoveredEntitiesChart

What Employers Should Know about HIPAA Slide Deck

columbia office
Phone: 803.253.6997
Toll Free: 888.540.9403
2422 Devine St. Suite B
Columbia, SC 29205
P.O. Box 5672
other offices
Greenville: 864.232.6723
Florence: 843.662.1500

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