Denial of coverage based on health status

[Guest Brook]

Can anyone advise me on the possible ramifications of a self-funded group health plan denying a member entry into the plan's coverage because of an ongoing illness? Would it make any difference if it was a new hire vs. an existing employee? I am not sure what regulations apply.

[Mary C]

We just amended our health care plan to allow enrollments when the employee is on a LOA because HIPAA prohibits discrimination in enrollment due to health status. All are carriers are fully insured managed care organizations. Our legal and ERISA advisors interpretted this to mean we could not deny enrollment to someone newly eligible or during annual enrollment simply because they are ill and on leave.