The U.S. Department of Labor's Employee Benefits Security Administration (EBSA) has released guidance to EBSA's national and regional offices as to whether supplemental health insurance coverage is deemed "excepted" under the Health Insurance Portability and Accountability Act (HIPAA).
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Download NowThe agency says that various situations have arisen that bring into question whether all of the coverage that is being marketed as similar supplemental coverage actually qualifies as such.
The new Field Assistance Bulletin establishes an enforcement safe harbor under which supplemental health insurance will be considered excepted benefits for purposes of the health reform provisions in Part 7 of ERISA. Similar supplemental coverage that does not meet the standards for the safe harbor may be subject to enforcement actions by the department.
To fall within the safe harbor, to be similar supplemental coverage, a policy, certificate, or contract of insurance must meet the standards in four criteria detailed in the safe harbor:
- Independent of primary coverage,
- Supplemental for gaps in primary coverage,
- Supplemental in value of coverage, and
- Similar to Medicare supplemental coverage.
This guidance has been coordinated with the Departments of Treasury, and Health and Human Services.
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