HIPAA compliance with LTD plans

[Guest RPFAFF]

With a standard LTD plan, the typical language used under Exclusions is generally something along the lines of - monthly benefits for any Total Disability will not be paid if caused by "an intentionally self-inflicted injury, while sane" - does this exclusion comply with the HIPAA nondiscrimination rules that state if a suicide attempt is the result of a medical or mental health condition (such as depression), benefits cannot be denied. Who determines whether the participant was "sane"? Does this even apply to LTD plans? I'm assuming they do because they fall under ERISA. Any clarification on this would be appreciated.

[jeanine]

We use a statement to the effect that self-inflicted injuries are excluded, except to the extent they are the direct cause of a mental or physical illness. "Sane" would be a bad standard indeed. As the Yates trial showed, severe mental illness is not necessarily insanity. I realize that a criminal definition of sanity might be different than a medical definition of sanity....I would just hate to be the one determining this.

[KIP KRAUS]

I never thought that HIPAA applied to any plans but medical plans.

What about the pre-ex in LTD plans? I don't think they would meet HIPAA pre-ex requirements and I haven't seen LTD plans change these provisions.

[Steve72]

Kipp's right, I think. HIPAA only applies to group health plans.

[jeanine]

I stand corrected and should actually know better. It's just that I hear the word "HIPAA" and go into overdrive. We had an interesting time convincing some of our self-funded health plans that it was indeed true that self-inflicted injuries can't be excluded across the board any more.

[Guest RPFAFF]

Thanks for the input. I wasn't sure about this one and I'm new to the area of LTD's and thought that because they are required to have the ERISA statement, that other applicable laws to ERISA like HIPAA apply. I stand corrected - thanks!