Date of this Version
The enactment of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its related legislation, the Newborns' and Mothers' Health Protection Act of 1996 (NMHPA) and the Mental Health Parity Act of 1996 (MHPA) (hereinafter collectively referred to as "HIPAA and its related legislation") signals a possible new role for the Employee Retirement Income Security Act of 1974 (ERISA), the federal law governing private health care plans. HIPAA and its related legislation represent a broadening, in the private health care context, of ERISA's Title I protective provisions from disclosure and fiduciary administration requirements to substantive benefit and coverage requirements in targeted areas. HIPAA and its related legislation also potentially signal a new approach by Congress to the issue of ERISA preemption of state insurance laws in the private health care plan context for those targeted areas where Congress has created new federal requirements. These changes may foreshadow a new willingness by Congress to use ERISA increasingly in the future to establish and enforce minimum federal standards, in targeted areas, for private health care plan coverage and benefits.
The future appears to hold a greatly expanded role for the federal courts in the enforcement of new Title I rights for participants in private health care plans. The new Title I rights created by HIPAA and its related legislation are enforceable in federal court as private causes of action by individual plan participants via ERISA's civil enforcement scheme. Although the most blatant violations are likely to be addressed by state insurance commissioners or the Secretary of Labor, resources available for enforcement at the state and federal levels are necessarily limited. With the potential for class actions and ERISA's provision for the award of attorney's fees and costs, individual plaintiffs are likely to play a significant enforcement role. Their claims will most likely be heard in the federal courts.