HIPAA Management

Title I of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) protects health insurance coverage for workers and their families when they change or lose their jobs. The Advantage HRM system allows users to produce HIPAA certificates and related reports either upon request or when certain triggering events have occurred. Many of the same triggering events that are utilized in HIPAA reporting are also handled by Advantage HRM through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).

HIPAA functionality in HR is designed to keep track of certain events that have been identified as HIPAA triggering, and upon request, process the accumulated HIPAA triggers and produce HIPAA Certificates when the HIPAA triggers correspond to active enrollment in HIPAA Qualifying Benefits.

HIPAA was created to ensure that any person is able to get health care coverage that matches the health care coverage for which the person is no longer eligible due to a HIPAA Triggering Event. In order to receive a HIPAA Certificate, two things must take place. First, an event must be entered into the HR system that will create a HIPAA Trigger. Once a HIPAA Trigger has been created, a second process will determine if an employee was enrolled in a HIPAA Qualifying Benefit at the time the triggering event took place.

On a monthly basis, the Dependents Losing Coverage (HB07000M) procedure should be executed to create HIPAA Triggers for any dependents who will soon reach the COBRA Age Limit for creditable coverage. If your site participates in COBRA, this procedure should already be a part of your Monthly processing. HIPAA Triggers will be created based upon the same Age Limit and Tickler Days currently identified in the HB07000M job.

The COBRA Coverage Ending – HIPAA Program (HH07100M) procedure should be added as part of your Monthly processing. This batch job creates HIPAA Triggers for any employees currently enrolled in COBRA whose COBRA Coverage will soon be coming to an end. HIPAA Triggers will be created for all employees currently enrolled in COBRA whose coverage will be ending or has ended during the range of dates provided in the job setup.

This topic includes the following areas:

• Identifying HIPAA Qualifying Benefits

• Generating HIPAA Triggers

• Processing HIPAA Information

• Producing HIPAA Certificates

• Please refer to HIPAA Exhibit Instructions for more information on setting up your site for HIPAA processing.