Legislative Issues & Policies - HIPAA Recreational Injury Technical Correction Act

Introduction

Regulations adopted in 2001 by the Internal Revenue Service, the Pension and Welfare Benefits Administration and the Health Care Financing Administration concerned recreational riders (and other forms of recreation) because the federal provisions permit health insurers to exclude coverage for injuries resulting from riding and other forms of “dangerous” recreation.

While the rules state that an employer cannot refuse health-care coverage under a group plan to an employee based on participation in recreational activities, they permit health insurers to deny coverage for injuries sustained in connection with such recreational activities, effectively reaching the same result. 

Background

These proposed regulations permit exclusions from health insurance coverage based on activities, including horseback riding, which the AHC believes Congress sought to protect.  In 1996, Congress passed the Health Insurance Portability and Accountability Act.  As we read this Act, it was intended to prohibit health insurers from denying health coverage based on a worker's pre-existing medical condition or participation in legal recreational activities.

The legislative history of the Act states that the law "is intended to ensure, among other things, that individuals are not excluded from health-care coverage due to their participation in activities such as motorcycling, snowmobiling, all-terrain vehicle riding, horseback riding, skiing and other similar activities."
Legislation
Representatives Bart Stupak (D-MI) and Michael C. Burgess (R-TX) have introduced "The HIPAA Recreational Injury Technical Correction Act" (H.R. 1076).  This bill would bar employers from discriminating against those who take part in legal recreational activities such as horseback riding, motorcycling, ATV riding and snowmobiling in the health-insurance programs they offer their workers.   H.R. 1076 was referred to the House Committee on Energy and Commerce, the House Ways and Means Committee and subsequently the House Ways and Means Subcommittee on Health, and the House Education and Labor Committee.
Senators Susan Collins (R-ME) and Russ Feingold (D-WI) introduced identical legislation (S. 616) in the Senate.  S. 616 was referred to the Senate Health, Education, Labor and Pensions Committee.
Specifically, the bill provides that:

a group health plan, or a health insurance issuer offering group health insurance coverage in connection with a group health plan, may not deny benefits otherwise provided under the plan or coverage for the treatment of an injury solely because such injury was sustained while engaged in any particular mode of transportation specified in the plan consisting of the use of a motorcycle, snowmobile, all-terrain vehicle, or other similar recreational vehicle or horseback riding.

The Senate passed identical legislation in the 108th Congress.

AHC Position

The American Horse Council supports this legislation and will work with a coalition of other recreational groups to ensure its passage. The AHC sent letters to Representatives Bart Stupak (D-MI) and Michael C. Burgess (R-TX) and Senators Susan Collins (R-ME) and Russ Feingold (D-WI) endorsing "The HIPAA Recreational Injury Technical Correction Act." Read a sample letter here (PDF)