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[Billing Codes: 4120-01-P; 4830-01-P; 4510-29-P] - page 6 / 83

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191).2 These titles of HIPAA include substantially similar changes to the Internal Revenue Code,

the Employee Retirement Income Security Act (ERISA), and the Public Health Service Act (PHS

Act) relating to group health plans and issuers of group health insurance coverage.3 Certain other

provisions in Titles I and IV of HIPAA amended only ERISA or only the PHS Act. In particular,

the PHS Act, as amended by HIPAA, contains provisions governing health insurance issued to

small groups and health insurance sold in the individual market. The regulations implementing

these provisions added by HIPAA were made available to the public on April 1, 1997 and

published in the Federal Register on April 8, 1997. The group market regulations were issued

jointly by the Secretaries of the Treasury, Labor, and Health and Human Services (HHS) (62 FR

16894). The individual market regulations were issued only by HHS (62 FR 16985). See also 62

FR 31669 - 31670 and 31690 - 31696 (June 10, 1997) (containing technical corrections to both

the group market and individual market regulations).

NMHPA applies to health coverage in the large and small group markets, and in the

individual market. The Secretaries of the Treasury, Labor, and HHS share jurisdiction over the

NMHPA provisions. These provisions are substantially similar, except as follows:

The NMHPA provisions in the Code generally apply to all group health plans (including

2 NMHPA amended Chapter 100 of Subtitle K of the Code, Part 7 of Subtitle B of Title I of the Employee Retirement Income Security Act (ERISA), and Title XXVII of the Public Health Service Act (PHS Act).

3 The terms group health plan and health insurance issuer are defined in Code section 9832(a) and (b)(2), ERISA section 733(a) and (b)(2), and PHS Act section 2791(a) and (b)(2). The term group health insurance coverage is defined in ERISA section 733(b)(4) and PHS Act section 2791(b)(4). Generally, any health insurance coverage that does not meet the definition of group health insurance coverage is individual coverage even if State law treats the coverage as group coverage for other purposes. The terms individual health insurance coverage and individual market are defined in PHS Act section 2791(b)(5) and (e)(1).

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