Are Disability Insurance Companies and Other Insurance Benefits Companies Covered Entities under HIPAA?

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Introduction

This article covers what kind of insurance companies may be regarded as HIPAA "covered entities."


What Kinds of Insurance Companies are NOT Regarded as HIPAA "Covered Entities"? The "Excepted Benefits" Rule

Generally, disability insurance companies both short- and long-term), are not regarded as covered entities under HIPAA. That is, the law does not deem these companies to be healthcare plans or providers.

In addition, the following additional types of insurance are also generally not “health plans,” and therefore are not covered by HIPAA:

1. Workers' compensation benefits plans
2. Automobile liability insurance coverage that includes coverage for medical payments.
   

The HIPAA Administrative Simplification regulations specifically exclude from the definition of a “health plan,” "any policy, plan, or program to the extent that it provides, or pays for the cost of, excepted benefits, which are listed in section 2791(c)(1) of the Public Health Service Act, 42 U.S.C. 300gg-91(c)(1)." See 45 CFR 160.103.

As described in the Public Health Service Act, excepted benefits are one or more (or any combination thereof) of the following policies, plans, or programs:

1. Coverage only for accident, or disability income insurance, or any combination thereof.

2. Coverage issued as a supplement to liability insurance.

3. Liability insurance, including general liability insurance and automobile liability insurance.

4. Workers’ compensation or similar insurance.

5. Automobile medical payment insurance.

6. Credit-only insurance.

7. Coverage for on-site medical clinics

8. Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.
   
   

Are Life Insurance and Long-Term Care Insurace Companies Covered Entities?

In general, life insurance companies are not covered entities under HIPAA, and therefore are not regulated by it. 

Long-term care insurers may be covered entities, provided they meet certain conditions. If a long-term care insurer issues a policy that provides only excepted benefits, or issues a policy that only provides for income replacement (e.g., disability income protection), the long-term care insurer is generally not considered to be acting as a covered entity.