HIPAA-General

[Guest vwaters]

Can any health plan contain or require an actively-at-work provisions for employees and nondisability provision for dependents?

[Linda]

The IRS/DOL regs do not address this directly but my interpretation of ERISA 702 is that you cannot have a non-confinement rule (or a non-disability rule) for dependents’ coverage. Similarly, you cannot have an active work rule where the absences for non-health reasons are treated as active work. However, I think an active work rule that applies to all days off (e.g., scheduled days off AND absences for illness) is probably still okay.

[Guest vwaters]

Linda, thanks for your info. I was at a seminar recently where the instructor had heard that IRS and DOL previously stated they wanted to know if any insured carriers had refused to remove actively-at-work provisions from their medical policies. Have you heard anything on this?

[Linda]

I think in every case where I've pointed out the issue to an insurer, TPA or employer, the provisions have been removed. I have not worked with anyone who has argued that these provisions are permissible under HIPAA.