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Compliance Checklist for HIPAA Nondiscrimination Rules

Legislative Brief

HIPAA prohibits group health plans and health insurance issuers from discriminating against individuals based on health factors with respect to eligibility, premiums or coverage. Health factors include health status, medical condition (including both physical and mental illnesses), claims experience, receipt of health care, medical history, genetic information, evidence of insurability (including conditions arising out of acts of domestic violence and participation in activities such as motorcycling, snowmobiling, all-terrain vehicle riding, horseback riding, skiing and other similar activities) and disability.

HIPAA’s nondiscrimination rules prohibit discrimination within a group of similarly situated individuals. Health plans may treat distinct groups of similarly situated individuals differently, if the distinctions between or among the groups are not based on a health factor. 

In addition, HIPAA’s nondiscrimination rules do not prohibit a health plan from establishing more favorable rules for eligibility or premium rates for individuals with an adverse health factor, such as a disability.

The Department of Labor (DOL) issued the following checklist to assist plans and issuers to comply
with nondiscrimination rules under HIPAA.

 

Download PDF Compliance Checklist

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