What is COBRA & HIPAA

The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage up to 102 percent of the cost to the plan.

COBRA generally requires that group health plans sponsored by employers with 20 or more employees in the prior year offer employees and their families the opportunity for a temporary extension of health coverage (called continuation coverage) in certain instances where coverage under the plan would otherwise end.

The combined text of all the HIPAA Administrative Simplification Regulations have been combined into a single document of 115 pages by the HHS, which makes it a very lengthy read, but it is possible to summarize HIPAA in a few sentences and explain HIPAA in simple terms.

HIPAA was an attempt by Congress to improve efficiency in healthcare, eliminate wastage, combat fraud, and ensure that health information that can be tied to an individual and would allow them to be identified is protected and kept private and confidential.

HIPAA introduced a set of new standards for healthcare organizations to follow to ensure everyone was singing from the same hymn sheet. Standard codes and identifiers were created to make it easier for health information exchange and healthcare providers, health insurers, and their business associates were required to use the same codes for electronic transactions to ensure data could be exchanged efficiently. This saved a great deal of time, effort, and resulted in substantial cost savings.

HIPAA stipulated the allowable uses and disclosures of health information, restricting who is allowed to access health information and under what circumstances. HIPAA gave Americans the right to obtain copies of their health data to check their health records for errors and to share their records with whoever they wish. HIPAA also set standards for protecting health data to make it harder for health information to be accessed by individuals who had no right to view the information.

Title I protects health insurance coverage for individuals who lose or change jobs. It also prohibits group health plans from denying coverage to individuals with specific diseases and pre-existing conditions, and from setting lifetime coverage limits.