HIPAA Recreational Injury Technical Correction Act
Thursday, June 23, 2005
Regulations adopted in 2001 by the Internal Revenue Service, the Pension and Welfare Benefits Administration and the Health Care financing Administration concerned recreational riders (and other forms of recreation) because the federal provisions permit health insurers to exclude coverage for injuries resulting from riding and other forms of "dangerous" recreation.
While the rules state that an employer cannot refuse health-care coverage under a group plan to an employee based on participation in recreational activities, they permit health insurers to deny coverage for injuries sustained in connection with such recreational activities, effectively reaching the same result.
These proposed regulations permit exclusions from health insurance coverage based on activities, including horseback riding, which the AHC believes Congress sought to protect. In 1996, Congress passed the Health Insurance Portability and Accountability Act. As we read this Act, it was intended to prohibit health insurers from denying health coverage based on a worker's preexisting medical condition or participation in legal recreational activities.
The legislative history of the Act states that the law "is intended to ensure, among other things, that individuals are not excluded from health care coverage due to their participating in activities such as motorcycling, snowmobiling, all-terrain vehicle riding, horseback riding, skiing and other similar activities."
In March, Senators Susan Collins (R-ME) and Russell Feingold (D-WI) introduced legislation (S. 577) in the Senate that would prohibit health insurers from denying benefits to plan participants if they are inured while engaging in legal recreational activities like horseback riding. This bill is the same one that passed the Senate in the last Congress.
This bill provides that a group health plan or a health insurance issuer offering group insurance may not deny benefits otherwise provided under the plan or coverage for the treatment of an injury solely because such injury resulted from the participation of the insured in a legal recreational activity, such as riding.
This language is broad and essentially includes all legal recreational activities. The AHC supports this bill.
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