The regulations are designed to protect medical records and other individual confidential information that relate to a past, present or future physical or mental condition of the individual. The health information applies to oral, written or electronic communications. According to the regulations, protected information cannot be used or disclosed by a health plan under specific circumstances unless the patient provides consent. The consent can be of a general nature and need not be limited in duration. No consent by the patient is necessary for routine usage such as treatment payment purposes, quality management and business related functions.
Business related functions are limited to underwriting and external medical review.
Additionally, group health plans must give individuals a written or electronic explanation or statement of the intended uses or disclosures of protected information, including the patient's right to protect their individually identifiable health information and the individuals' right to file a complaint if privacy violations are suspected. Both civil and criminal penalties for violations will be imposed. WGA will require the cooperation of all employers in implementing and abiding by these new medical privacy standards. The law also mandates coverage for chiropractic visits and ensures speedy reviews of claims and appeals. This increase is in addition to the 13 to 15 percent increases already put into effect by many insurance companies to cover the higher costs of prescription drugs and spiraling doctor and hospital charges.