The IRS, Department of Labor, and DSHS have gotten together again to issue more HIPAA nondiscrimination rules, fleshing out rules issued in April 1997. The rules implement HIPAA's mandate that group health care eligibility, benefits, and premiums cannot discriminate on the basis of any health factor, except in connection with a "bona fide wellness program." The new rules answer questions left open by the 1997 regulations. Some of these areas a re summarized below.
Source of Injury.
The legislative history was clear that an individual cannot be denied coverage by a plan because he engages in high-risk activities like skydiving. The new rules confirm that a plan can exclude coverage for injuries caused by high-risk activities or by other behaviors like failure to wear a seatbelt or committing a crime. However, a plan cannot exclude injuries caused by domestic violence or by a health factor (such as a self-inflicted injury caused by depression).
