New interim final HIPPA rules question

[Guest Ruth]

I was told that the interim final rules and regulations prohibit insurers from not covering people that participate in certain activities: motoer cycling, horse back riding, skiing, etc. However, it supposedly allows insurer to exclude claims arising out of those activities. The rukes are to become effective in May. Any further information about this?

[Erik Read]

Not sure if it's gone through, I know that I wrote my local reps to oppose the passage. Haven't heard the outcome yet.

[KIP KRAUS]

Ruth:

That’s a new one on me. Are you talking about AD&D coverage exclusions or medical plan exclusions. I could see where an insurer may exclude such activities in an AD&D plan. I’ve never seen those types of exclusions in a medical plan. Of course now days any thing is possible.

[jeanine]

The DOL issued final rules on HIPAA non-discrimination a few months ago. I accessed the rules from this site. It's true--you may not exclude someone from participating in a plan due to these types of activities but you may exclude coverage from injuries arising out of. I'm not sure if your state insurance law would allow these types of exclusions but self-fundeds may. I, however, do not see motorcycling as a dangerous activity but an alternate means of transportation. I would not cover off-road motorbiking or sky-jumping, but these are different from motorcycle riding as far as I am concerned.

[Guest Debra Button]

I'm a horse person in addition to my day job as HR Manager (primarily responsible for benefits) and have been fielding TONS of questions from irate horse people on the "horsey" lists I'm on. They are all furious and fear that this will be a major problem for them. I've tried to reassure them somewhat. I know that I am making absolutely NO changes to our plan because of this and haven't run across any other plan adminstrators that are. The risk just isn't great enough. As a plan administrator I'd get more bang for my buck if I cut out mental health benefits or even just birth control pills rather than denying claims because someone's horse bit them. (and NO I'm not planning on cutting out those services, just an example that recreational activities are much less likely to increase my costs much as compared to other claims)

So how many of you are planning on making changes to your plan documents to disallow claims for certain recreational activities?

[Guest Ruth]

I printed the 44 some pages for the regs but cannot find the direct reference as to the exclusion of the claims due to the activites. Can someone point out the page or section?

Tx

[Guest Debra Button]

If you go the regs (you can find them at http://www.hcfa.gov/medicaid/hipaa/content...regulations.asp )and go to page 1379 - that is the first place mention of specific injury for recreational activities - a commentator spoke about not allowing exclusion of health coverage for those people who engage in certain recreational activities such as skiing and horse back riding. Then on page 1381 under "Source of Injury", left column, is where the rule talks about allowing plans to deny claims for these type of injuries.

Hope this helps.

[Guest Debra Button]

Forgot to mention that you need to click on PDF under the final rule heading to get to the latest reg from January.