Texas HIPAA Health Insurance

The Texas HIPAA health insurance laws, also known as the Health Insurance Portability and Accountability Act, were established in 1996 by Congress to protect workers and their families' health insurance coverage and to establish standards for insurance providers and employers. The HIPAA consists of two parts, Title I and Title II. Title I protects workers if they switch jobs or get laid off from a current job. The protection also extends to the workers family members. Title II covers a different aspect of the health insurance laws, requiring health care facilities, employees, and health insurance providers to abide by nationally established standards. Title II is also known as the Administrative Simplification (AS) provisions, which make use of electronic data systems in Texas and throughout the U.S. to make health care matters much more efficient than in the past.

Title I of the HIPAA's main objective was to amend the Public Health Service Act and the Employee Retirement Income Security Act. Under Title I, health insurance providers in Texas and throughout the U.S. cannot deem workers eligible or ineligible simply based on disabilities, genetics, or their medical history. Health insurance companies in Texas and other states used to be able to place restrictions on health insurance plans for workers who had preexisting conditions. However, Title I limits these restrictions that the insurance providers are allowed to put on benefits for workers who fall in this category. Further, Title I also prohibits health insurance providers from placing restrictions on or denying coverage to workers with preexisting conditions.

Title II of HIPPA was created first for its Administrative Simplification rules, which require the Department of Health and Human Services to assist in advancing the efficiency and effectiveness of the health care system in Texas and all other states. Another aspect of Title II is its programs to monitor abuse and fraud within the health insurance and health care industries. Title II also sets both criminal and civil penalties for those who violate the laws. The Department of Health and Human Services established five main rules: the Security, Privacy, Enforcement, Unique Identifiers, and Transactions and Code Sets Rules.

The Security Rule consists of three sections: administrative, physical, and technical safeguards. The administrative safeguards provide guidelines for the health care field to abide by, especially relating to security issues. The Privacy Rule expands on this, placing restrictions on disclosing information regarding an individual's health care status. The Enforcement Rule sets penalties, mainly civil fines and violations for those who violated HIPAA laws. The Unique Identifiers Rule assigns a ten digit National Provider Identifier number to any entity such as hospitals or doctors in order to promote the efficiency of the health care system in Texas and throughout the U.S. Lastly, the Transactions and Code Sets Rules relate to many aspects of health care such as inquiries about eligibility and benefits and the transmission of health care information.

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