The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that regulates most employer group health plans, health insurance companies, and health care providers. Plano ISD as a non-federal governmental plan is exempt from this law. However, our Plan is voluntarily compliant with certain aspects of HIPAA. Notice of HIPAA Exemption (56 KB)

The two areas described below relate to the Privacy Regulations and Certificates of Creditable Coverage that are mandated by HIPAA.

Privacy Regulations

In April 2001, the first-ever federal privacy standards to protect patients' medical records and other health information were finalized. These privacy regulations are part of HIPAA, and will provide patients with access to their medical records and more control over how their personal health information is used and disclosed. Covered entities may include doctors, hospitals, other health care providers, and health plans, and most covered entities will become compliant during 2003.

Modifications to the law have clarified many issues, and are meant to ensure your continued access to quality health care. As a patient, you will see the effect of this legislation when you obtain medical care from a health care provider, or require access to your personal medical records maintained by that provider. The legislation still allows health care providers and health plans to use and disclose information as needed in the course of providing treatment, payment, or other health care operations. All of our health plan's business associates, including our third party administrator Harrington Benefit Services, are compliant with these regulations. Therefore, there should be no disruption in claims payment, provided all health care providers submit claims that are compliant with the new regulations.

The Notice of Privacy Practices for Plano ISD Health Plans (22 KB) explains the rights and responsibilities of each covered person and of the Plan, and describes how medical information may be used and disclosed. It is very important that every employee review this notice.

If you have any questions or would like a paper copy of the Notice of Privacy Practices, please contact our Privacy Officer at benefits@pisd.edu.

More detailed information regarding the HIPAA Privacy regulations is available through the U.S. Department of Health and Human Services.

Certificates of Creditable Coverage

One aspect of HIPAA that may affect you and your family is how it has changed pre-existing condition limitations when you leave Plano ISD and obtain coverage through a new employer's plan. Many health plans have a pre-existing condition clause that limits or excludes coverage for a condition or diagnosis you had before joining that plan. However, if your new employer's plan is subject to this area of HIPAA, they may reduce or remove their limitation on pre-existing conditions. If you have had coverage under a previous health plan(s) for 18 months or longer, without a break in coverage of more than 63 days, then this may be available to you.

A 63-day break in coverage (not counting time spent in any waiting periods) will disqualify any coverage before that break as being creditable coverage. Thus, if you experience a COBRA Qualifying Event and lose coverage, you may need to elect COBRA coverage if your new health plan's waiting period will not begin until more than 63 days later.

When your Plano ISD coverage ends, we will automatically send you a "Certificate of Creditable Coverage". You should provide this certificate to your new employer's plan, and ask them if it will affect any pre-existing condition limitation.

This is merely a summary of HIPAA provisions and is not intended to be all-inclusive.