【跨境合规】美国《健康保险便利和责任法案》（HIPPA）中英对照摘录（二）

第 707 条　行政规章

劳工部长依据《1996 年健康保险流通与责任法》第 104 条，可以为落实本部分条文，制定必要且适当的规章。劳工部长可根据执行需要，颁布临时最终规则，用于落实本部分规定。

(b) 针对医疗保险机构的执法修订

修订该法第 502 (b) 条（《美国法典》第 29 编 §1132 (b)），在末尾新增如下一款：

“(3) 部长无权依据本部分，针对为团体医保计划（第 706 (a)(1) 定义）提供医疗保险保障的保险机构，强制执行第 7 部分的任何义务。本款不影响部长为落实第 7 部分而颁布规章的权力。”

(c) 向参保人与受益人披露信息

(1) 总则。修订该法第 104 (b)(1) 条（《美国法典》第 29 编 §1024 (b)(1)），修改 (B) 项之后的文本：

(A) 删除 “102 (a)(1),”，替换为 “102 (a)(1)（团体医保计划（第 706 (a)(1) 定义）项下保障服务或福利发生重大缩减的情形除外）”；

(B) 在末尾新增如下语句：

“若发生第 102 (a)(1) 条所述变更，且该变更造成团体医保计划（第 706 (a)(1) 定义）项下保障福利发生重大缩减，计划发起方应当在该变更方案通过之日起60 日内，向参保人、受益人提供该变更的摘要说明。作为替代方案，计划发起方可以最长不超过90 日为周期，定期提供该摘要。部长应当在《1996 健康保险流通与责任法》颁布后180 天内出台规章，规定团体医保计划可采用邮寄以外的替代方式，向参保人、受益人告知保障福利重大缩减事项。”

(2) 计划说明与摘要文件。修订该法第 102 (b) 条（《美国法典》第 29 编 §1022 (b)）：

(A) 在 “计划管理模式；” 之后插入：“对于团体医保计划（第 706 (a)(1) 定义），写明医疗保险机构（第 706 (b)(2) 定义）是否承担本计划的资金筹措或管理（含理赔支付）工作；如承担，写明该机构名称与地址；”；

(B) 在 “本计划项下福利” 之后插入：“包含劳工部办事机构信息；参保人、受益人可通过该机构，咨询、获取其依据本法以及《1996 健康保险流通与责任法》，就团体医保计划项下健康福利所享有的权利相关帮助与信息。”

(d) 向不适用本法的计划提供保险保障的保险机构的处理规则

修订该法第 4 (b) 条（《美国法典》第 29 编 §1003 (b)），在第 (5) 款之后新增：

“若某团体医保计划本身不受本编规定约束，则仅仅因为保险机构向该计划提供团体医保保险保障，B 分编第 7 部分的规定，不适用于该保险机构。”

(e) 特定福利安排的报告义务与执法修订

(1) 总则。修订该法第 101 条（《美国法典》第 29 编 §1021）：

(A) 将原 (g) 款重新编号为 (h) 款；

(B) 在 (f) 款之后新增新的 (g) 款：

“(g) 特定福利安排的报告义务。部长可通过规章，要求不属于团体医保计划、但提供医疗福利（第 706 (a)(2) 定义）的多雇主福利安排主体提交报告；报告周期最多一年一次，报告格式、方式由部长规定，用于评估第 7 部分的要求在该类福利中的落地执行情况。”

(2) 执法条文修订

(A) 总则。修订该法第 502 条（《美国法典》第 29 编 §1132）：

(i) 在 (a)(6) 款，将 “subsection (c)(2) or (i) or (l)” 修改为 “paragraph (2), (4), or (5) of subsection (c) or under subsection (i) or (l)”；

(ii) 修改 (c) 款最后两句，删除 “For purposes of this paragraph” 一直到 “The Secretary and” 的全部文本，替换为：

“(5) 对于拒不提交、拒绝按第 101 (g) 条配套规章要求向部长提交材料的主体，部长可按每日最高 1000 美元标准处以民事罚款，从拒不履行义务当日起计算。

“(6) 部长以及”。

(B) 技术性配套修订。修订第 502 (c)(1) 条，在末尾增加句子：

“就本款而言，针对单个参保人发生的 (A) 项类违规，以及针对单个参保人 / 受益人发生的 (B) 项类违规，每一件均视作独立的一项违法行为。”

(3) 执法权协调。修订该法第 506 条（《美国法典》第 29 编 §1136），末尾新增一款：

“(c) 特定福利安排层面，联邦与各州执法权限协调。各州可与部长签署协议，将部长依据 502、504 条，针对不属于团体医保计划、但提供医疗福利的多雇主福利安排行使的部分或全部执法权力，委托给州政府行使。”

(f) 配套修订

(1) 修订第 514 (b) 条，末尾新增第 (9) 款：

“(9) 关于团体医保计划的更多规定，参见第 704 条。”

(2)(A) 修改第一编 B 分编第 6 部分标题，旧标题删除，替换为：

第 6 部分 —— 团体医保计划：延续保障以及附加标准

(B) 修改法案第 1 条目录，删除旧的第 6 部分目录条目，替换为：

第 6 部分 —— 团体医保计划：延续保障以及附加标准

(3) 修改法案第 1 条目录，在第 6 部分条目之后，插入第 7 部分完整目录：

第 7 部分 —— 团体医保计划：可携带性、准入与续保要求

第 701 条：通过限制既往症除外条款，提升医保可携带性

第 702 条：禁止基于健康状况歧视参保人与受益人

第 703 条：多雇主计划与多雇主福利安排下的保证续保

第 704 条：联邦法优先适用；州的灵活空间；条文释义

第 705 条：团体医保计划特殊规则

第 706 条：定义

第 707 条：行政规章

(g) 生效日期

(1) 总则。除本条另有规定外，本条全部修订，适用于1997 年 6 月 30 日之后开启计划年度的团体医保计划。

(2) 可累计有效保障的认定规则

(A) 保障期间计算

(i) 总则：除 (ii) 项例外，在适用 B 分编第 7 部分计算可累计有效保障时，1996 年 7 月 1 日之前的保障期间不予计入。

(ii) 特定情形特别规则。劳工部长依据第 104 条，制定流程：对于受 (i) 项限制、但本应当可以计入保障时长的 1996‑07‑01 之前的保障经历，个人可以提交书面文件或其他证明材料，申请认定该段可累计有效保障。

(B) 保障证明文件相关

(i) 总则：除 (ii)、(iii) 项，《雇员退休收入保障法》第 701 (e) 条（本次新增条文）适用于1996‑06‑30 之后发生的事件。

(ii) 1997 年 6 月 1 日之前，无需出具该证明文件。

(iii) 1996‑06‑30 之后、1996‑10‑01 之前发生的事件：仅当个人书面提出申请，机构才需要出具保障证明。

(C) 过渡规则。个人申请认定 1996‑06‑30 前的保障（该情形不强制出具证明）：

(i) 个人可以提交其他可信证据，用于确认可累计有效保障时长；

(ii) 团体医保计划、医疗保险机构如本着善意遵守修订后的法律，无论是否认定该段旧保障，均不会因此遭受处罚或执法追责。

(3) 集体谈判协议特殊规则。除本款第 (2) 项，对于依据本法颁布前已经签署生效的集体谈判协议设立的团体医保计划，在 “最后一份相关集体谈判协议到期日” 与 “1997‑07‑01” 二者中较晚的时点之前开启的计划年度，B 分编第 7 部分（701 (e) 条除外）不适用。

释义：仅仅为满足本部分法律要求而修订计划文本的集体谈判协议修订，不视作原集体谈判协议到期终止。

(4) 规章的时间要求。劳工部长应当不晚于 1997 年 4 月 1 日，出台落实本次修订所必要的规章。

(5) 执法缓冲期。在1998‑01‑01 之前；或者前述第 (4) 款规章发布日（二者取更晚者）之前，如果团体医保计划、医疗保险机构本着善意尝试遵守新规，即便存在违反本次修订条文的情形，不得对其采取执法行动。

‘‘SEC. 707. REGULATIONS.

‘‘The Secretary, consistent with section 104 of the Health Care Portability and Accountability Act of 1996, may promulgate such regulations as may be necessary or appropriate to carry out the provisions of this part. The Secretary may promulgate any interim final rules as the Secretary determines are appropriate to carry out this part.’’.

(b) ENFORCEMENT WITH RESPECT TO HEALTH INSURANCE ISSUERS.—Section 502(b) of such Act (29 U.S.C. 1132(b)) is amended by adding at the end the following new paragraph:

‘‘(3) The Secretary is not authorized to enforce under this part any requirement of part 7 against a health insurance issuer offering health insurance coverage in connection with a group health plan (as defined in section 706(a)(1)). Nothing in this paragraph shall affect the authority of the Secretary to issue regulations to carry out such part.’’.

(c) DISCLOSURE OF INFORMATION TO PARTICIPANTS AND BENEFICIARIES.—

(1) IN GENERAL.—Section 104(b)(1) of such Act (29 U.S.C. 1024(b)(1)) is amended in the matter following subparagraph (B)—

(A) by striking ‘‘102(a)(1),’’ and inserting ‘‘102(a)(1)(other than a material reduction in covered services or benefits provided in the case of a group health plan (as defined in section 706(a)(1))),’’; and

(B) by adding at the end the following new sentences:

‘‘If there is a modification or change described in section 102(a)(1) that is a material reduction in covered services or benefits provided under a group health plan (as defined in section 706(a)(1)), a summary description of such modification or change shall be furnished to participants and beneficiaries not later than 60 days after the date of the adoption of the modification or change. In the alternative, the plan sponsors may provide such description at regular intervals of not more than 90 days. The Secretary shall issue regulations within 180 days after the date of enactment of the Health Insurance Portability and Accountability Act of 1996, providing alternative mechanisms to delivery by mail through which group health plans (as so defined) may notify participants and beneficiaries of material reductions in covered services or benefits.’’.

(2) PLAN DESCRIPTION AND SUMMARY.—Section 102(b) of such Act (29 U.S.C. 1022(b)) is amended—

(A) by inserting ‘‘in the case of a group health plan (as defined in section 706(a)(1)), whether a health insurance issuer (as defined in section 706(b)(2)) is responsible for the financing or administration (including payment of claims) of the plan and (if so) the name and address of such issuer;’’ after ‘‘type of administration of the plan;’’; and

(B) by inserting ‘‘including the office at the Department of Labor through which participants and beneficiaries may seek assistance or information regarding their rights under this Act and the Health Insurance Portability and Accountability Act of 1996 with respect to health benefits that are offered through a group health plan (as defined in section 706(a)(1))’’ after ‘‘benefits under the plan’’.

(d) TREATMENT OF HEALTH INSURANCE ISSUERS OFFERING HEALTH INSURANCE COVERAGE TO NONCOVERED PLANS.—Section 4(b) of such Act (29 U.S.C. 1003(b)) is amended by adding at the end (after and below paragraph (5)) the following:

‘‘The provisions of part 7 of subtitle B shall not apply to a health insurance issuer (as defined in section 706(b)(2)) solely by reason of health insurance coverage (as defined in section 706(b)(1)) provided by such issuer in connection with a group health plan (as defined in section 706(a)(1)) if the provisions of this title do not apply to such group health plan.’’.

(e) REPORTING AND ENFORCEMENT WITH RESPECT TO CERTAIN ARRANGEMENTS.—

(1) IN GENERAL.—Section 101 of such Act (29 U.S.C. 1021) is amended—

(A) by redesignating subsection (g) as subsection (h), and

(B) by inserting after subsection (f) the following new subsection:

‘‘(g) REPORTING BY CERTAIN ARRANGEMENTS.—The Secretary may, by regulation, require multiple employer welfare arrangements providing benefits consisting of medical care (within the meaning of section 706(a)(2)) which are not group health plans to report, not more frequently than annually, in such form and such manner as the Secretary may require for the purpose of determining the extent to which the requirements of part 7 are being carried out in connection with such benefits.’’.

(2) ENFORCEMENT.—

(A) IN GENERAL.—Section 502 of such Act (29 U.S.C. 1132) is amended—

(i) in subsection (a)(6), by striking ‘‘under subsection (c)(2) or (i) or (l)’’ and inserting ‘‘under paragraph (2), (4), or (5) of subsection (c) or under subsection (i) or (l)’’; and

(ii) in the last 2 sentences of subsection (c), by striking ‘‘For purposes of this paragraph’’ and all that follows through ‘‘The Secretary and’’ and inserting the following:

‘‘(5) The Secretary may assess a civil penalty against any person of up to $1,000 a day from the date of the person’s failure or refusal to file the information required to be filed by such person with the Secretary under regulations prescribed pursuant to section 101(g).

‘‘(6) The Secretary and’’.

(B) TECHNICAL AND CONFORMING AMENDMENT.—Section 502(c)(1) of such Act (29 U.S.C. 1132(c)(1)) is amended by adding at the end the following sentence:

‘‘For purposes of this paragraph, each violation described in subparagraph (A) with respect to any single participant, and each violation described in subparagraph (B) with respect to any single participant or beneficiary, shall be treated as a separate violation.’’.

(3) COORDINATION.—Section 506 of such Act (29 U.S.C. 1136) is amended by adding at the end the following new subsection:

‘‘(c) COORDINATION OF ENFORCEMENT WITH STATES WITH RESPECT TO CERTAIN ARRANGEMENTS.—A State may enter into an agreement with the Secretary for delegation to the State of some or all of the Secretary’s authority under sections 502 and 504 to enforce the requirements under part 7 in connection with multiple employer welfare arrangements, providing medical care (within the meaning of section 706(a)(2)), which are not group health plans.’’.

(f) CONFORMING AMENDMENTS.—

(1) Section 514(b) of such Act (29 U.S.C. 1144(b)) is amended by adding at the end the following new paragraph:

‘‘(9) For additional provisions relating to group health plans, see section 704.’’.

(2)(A) Part 6 of subtitle B of title I of such Act (29 U.S.C. 1161 et seq.) is amended by striking the heading and inserting the following:

‘‘PART 6—CONTINUATION COVERAGE AND ADDITIONAL STANDARDS FOR GROUP HEALTH PLANS’’.

(B) The table of contents in section 1 of such Act is amended by striking the item relating to the heading for part 6 of subtitle B of title I and inserting the following:

‘‘PART 6—CONTINUATION COVERAGE AND ADDITIONAL STANDARDS FOR GROUP HEALTH PLANS’’.

(3) The table of contents in section 1 of such Act (as amended by the preceding provisions of this section) is amended by inserting after the items relating to part 6 the following new items:

‘‘PART 7—GROUP HEALTH PLAN PORTABILITY, ACCESS, AND RENEWABILITY REQUIREMENTS

‘‘Sec. 701. Increased portability through limitation on preexisting condition exclusions.

‘‘Sec. 702. Prohibiting discrimination against individual participants and beneficiaries based on health status.

‘‘Sec. 703. Guaranteed renewability in multiemployer plans and multiple employer welfare arrangements.

‘‘Sec. 704. Preemption; State flexibility; construction.

‘‘Sec. 705. Special rules relating to group health plans.

‘‘Sec. 706. Definitions.

‘‘Sec. 707. Regulations.’’.

(g) EFFECTIVE DATES.—

(1) IN GENERAL.—Except as provided in this section, this section (and the amendments made by this section) shall apply with respect to group health plans for plan years beginning after June 30, 1997.

(2) DETERMINATION OF CREDITABLE COVERAGE.—

(A) PERIOD OF COVERAGE.—

(i) IN GENERAL.—Subject to clause (ii), no period before July 1, 1996, shall be taken into account under part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (as added by this section) in determining creditable coverage.

(ii) SPECIAL RULE FOR CERTAIN PERIODS.—The Secretary of Labor, consistent with section 104, shall provide for a process whereby individuals who need to establish creditable coverage for periods before July 1, 1996, and who would have such coverage credited but for clause (i) may be given credit for creditable coverage for such periods through the presentation of documents or other means.

(B) CERTIFICATIONS, ETC.—

(i) IN GENERAL.—Subject to clauses (ii) and (iii), subsection (e) of section 701 of the Employee Retirement Income Security Act of 1974 (as added by this section) shall apply to events occurring after June 30, 1996.

(ii) NO CERTIFICATION REQUIRED TO BE PROVIDED BEFORE JUNE 1, 1997.—In no case is a certification required to be provided under such subsection before June 1, 1997.

(iii) CERTIFICATION ONLY ON WRITTEN REQUEST FOR EVENTS OCCURRING BEFORE OCTOBER 1, 1996.—In the case of an event occurring after June 30, 1996, and before October 1, 1996, a certification is not required to be provided under such subsection unless an individual (with respect to whom the certification is otherwise required to be made) requests such certification in writing.

(C) TRANSITIONAL RULE.—In the case of an individual who seeks to establish creditable coverage for any period for which certification is not required because it relates to an event occurring before June 30, 1996—

(i) the individual may present other credible evidence of such coverage in order to establish the period of creditable coverage; and

(ii) a group health plan and a health insurance issuer shall not be subject to any penalty or enforcement action with respect to the plan’s or issuer’s crediting (or not crediting) such coverage if the plan or issuer has sought to comply in good faith with the applicable requirements under the amendments made by this section.

(3) SPECIAL RULE FOR COLLECTIVE BARGAINING AGREEMENTS.—Except as provided in paragraph (2), in the case of a group health plan maintained pursuant to one or more collective bargaining agreements between employee representatives and one or more employers ratified before the date of the enactment of this Act, part 7 of subtitle B of title I of Employee Retirement Income Security Act of 1974 (other than section 701(e) thereof) shall not apply to plan years beginning before the later of—

(A) the date on which the last of the collective bargaining agreements relating to the plan terminates (determined without regard to any extension thereof agreed to after the date of the enactment of this Act), or

(B) July 1, 1997.

For purposes of subparagraph (A), any plan amendment made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement of such part shall not be treated as a termination of such collective bargaining agreement.

(4) TIMELY REGULATIONS.—The Secretary of Labor, consistent with section 104, shall first issue by not later than April 1, 1997, such regulations as may be necessary to carry out the amendments made by this section.

(5) LIMITATION ON ACTIONS.—No enforcement action shall be taken, pursuant to the amendments made by this section, against a group health plan or health insurance issuer with respect to a violation of a requirement imposed by such amendments before January 1, 1998, or, if later, the date of issuance of regulations referred to in paragraph (4), if the plan or issuer has sought to comply in good faith with such requirements.