Table 2.  Weighted Summary of Violation Rates

Statute - Measure

Large

Small

Multi

All

700 - Part 7 Provisions

Plans subject to statute

91,459

1,217,807

1,759

1,311,026

Plans with violations

46,048

547,086

1,058

594,192

Weighted violation rate

50.3%

44.9%

60.1%

45.3%

700.1 - HIPAA Violations

Plans subject to statute

91,459

1,217,807

1,759

1,311,026

Plans with violations

36,890

432,723

879

470,493

Weighted violation rate

40.3%

35.5%

50.0%

35.9%

700.2 - Mental Health Parity Act Violations

Plans subject to statute

81,458

194,725

1,670

277,854

Plans with violations

6,488

15,454

332

22,274

Weighted violation rate

8.0%

7.9%

19.9%

8.0%

700.3 - Newborns' and Mothers' Health Protection Act Violations

Plans subject to statute

39,220

343,088

1,309

383,617

Plans with violations

7,406

126,726

281

134,413

Weighted violation rate

18.9%

36.9%

21.4%

35.0%

700.4 - Women's Health and Cancer Rights Act Violations

Plans subject to statute

91,459

1,217,807

1,759

1,311,026

Plans with violations

16,964

268,907

303

286,174

Weighted violation rate

18.5%

22.1%

17.2%

21.8%

Table 3.  95% Confidence Limits for Weighted Violation Rates in All Plans
Confidence Limits for Violation Rates

Statute

Violation Rate

Standard Error

Lower 95% Confidence Limit

Upper 95% Confidence Limit

700 - Part 7 Provisions

45%

2.3%

41%

50%

700.1 - HIPAA Violations

36

2.2

31

40

700.2 - Mental Health Parity Act Violations

8.0

2.4

3.3

13

700.3 - Newborns' and Mothers' Health Protection Act Violations

35

4.1

27

43

700.4 - Women's Health and Cancer Rights Act Violations

22

1.9

18

26

Table 4A.  95% Confidence Limits for Weighted Violation Rates in Each Sample
Confidence Limits for Violation Rates
Sample=Large

Statute

Violation Rate

Standard Error

Lower 95% Confidence Limit

Upper 95% Confidence Limit

700 - Part 7 Provisions

50%

2.4%

46%

55%

700.1 - HIPAA Violations

40

2.3

36

45

700.2 - Mental Health Parity Act Violations

8.0

1.4

5.3

11

700.3 - Newborns' and Mothers' Health Protection Act Violations

19

2.9

13

25

700.4 - Women's Health and Cancer Rights Act Violations

19

1.9

15

22

Table 4B.  95% Confidence Limits for Weighted Violation Rates in Each Sample
Confidence Limits for Violation Rates
Sample=Small

Statute

Violation Rate

Standard Error

Lower 95% Confidence Limit

Upper 95% Confidence Limit

700 - Part 7 Provisions

45%

2.5%

40%

50%

700.1 - HIPAA Violations

36

2.4

31

40

700.2 - Mental Health Parity Act Violations

7.9

3.4

1.1

15

700.3 - Newborns' and Mothers' Health Protection Act Violations

37

4.6

28

46

700.4 - Women's Health and Cancer Rights Act Violations

22

2.1

18

26

Table 4C.  95% Confidence Limits for Weighted Violation Rates in Each Sample
Confidence Limits for Violation Rates
Sample=Multi

Statute

Violation Rate

Standard Error

Lower 95% Confidence Limit

Upper 95% Confidence Limit

700 - Part 7 Provisions

60%

2.2%

56%

64%

700.1 - HIPAA Violations

50

2.2

46

54

700.2 - Mental Health Parity Act Violations

20

1.8

16

23

700.3 - Newborns' and Mothers' Health Protection Act Violations

21

2.1

17

26

700.4 - Women's Health and Cancer Rights Act Violations

17

1.7

14

20

Table 5A.  Violation Rates for Single-Employer Plans by Statute and Plan Size
(Weighted Violation Rates)

Number of Participants

700
Part 7
Provisions

700.1
HIPAA
Violations

700.2
Mental Health Parity Act Violations

700.3
Newborns' and Mothers' Health Protection Act Violations

700.4
 Women's Health and Cancer Rights Act Violations

# of Cases

Violation Rate

# of Cases

Violation Rate

# of Cases

Violation Rate

# of Cases

Violation Rate

# of Cases

Violation Rate

None or not reported

12

23.2%

12

1.5%

4

0.0%

2

50.0%

12

10.9%

2-9

208

43.2

208

34.3

11

27.3

50

44.8

208

20.6

10-24

108

48.8

108

40.6

11

5.9

33

35.6

108

23.0

25-99

169

52.3

169

40.3

101

5.6

52

41.3

169

31.0

100-500

212

46.0

212

33.0

205

8.3

101

7.5

212

15.9

500 or more

154

37.0

154

34.9

152

1.9

84

14.2

154

10.9

All

863

45.3

863

35.9

484

7.9

322

35.1

863

21.8

Table 5B.  Violation Rates for Multi-employer Plans by Statute and Plan Size
(Weighted Violation Rates)

Number of Participants

700
Part 7
Provisions

700.1
HIPAA
Violations

700.2
Mental Health Parity Act Violations

700.3
Newborns' and Mothers' Health Protection Act Violations

700.4
 Women's Health and Cancer Rights Act Violations

# of Cases

Violation Rate

# of Cases

Violation Rate

# of Cases

Violation Rate

# of Cases

Violation Rate

# of Cases

Violation Rate

2-99

34

50.0%

34

44.1%

18

22.2%

16

18.8%

34

11.8%

100-499

111

52.3

111

41.4

109

15.6

84

22.6

111

14.4

500-999

95

68.0

95

53.1

93

21.8

74

26.1

95

25.0

1,000-4,999

122

67.9

122

60.5

121

23.3

95

20.1

122

17.6

5,000 or more

54

51.3

54

42.0

54

16.8

41

14.8

54

12.0

All

416

60.1

416

50.0

395

19.9

310

21.4

416

17.2

Table 6.  Detailed Violation Rates by Sample
(Weighted Violation Rates)

Violation

Large

Small

Multi

All

700 - Part 7 Provisions

50.3%

44.9%

60.1%

45.3%

700.1 - HIPAA Violations

40.3

35.5

50.0

35.9

H1 - Impermissible preexisting condition exclusion

26.5

23.6

31.8

23.8

701(a)(1) - 6-Month look-back violation

12.3

11.7

17.2

11.7

701(a)(1) [using 701(b)(1) definition] - Preex on genetic information

0.0

0.5

1.0

0.5

701(a)(2) - 12 Month (or 18 month) look-forward violation

10.4

9.4

18.4

9.5

701(a)(3) [using 701(c) definition] - Failure to offset

6.4

6.3

9.7

6.4

701(d)(1) - Impermissible preex on newborns

1.2

0.5

4.6

0.6

701(d)(2) - Impermissible preex on children adopted or placed for adoption

1.3

0.8

4.4

0.8

701(d)(3) - Pregnancy preex

1.4

3.3

5.1

3.2

29 CFR 2590.701-3(c) - Failure to give adequate generalized notices of preex

15.5

14.5

18.6

14.5

29 CFR 2590.701-5(d) - Failure to give adequate individualized notices of preex

11.7

10.4

10.9

10.5

Other - Impermissible preex

6.5

4.8

6.6

4.9

H2 - Failure to Provide Certificates

9.5

7.1

11.5

7.3

701(e)(1)(A)(i) - Automatically upon loss of coverage (COBRA covered plan)

4.0

0.8

5.6

1.0

701(e)(1)(A)(i) - By Plan (COBRA Covered)

3.0

0.8

5.3

0.9

701(e)(1)(A)(i) - By Issuer only pursuant to agreement (COBRA Covered)

1.0

0.0

0.2

0.1

701(e)(1)(A)(ii) - Automatically upon loss of coverage (Non COBRA Covered)

0.5

2.3

0.5

2.2

701(e)(1)(A)(ii) - By Plan (Non COBRA Covered)

0.2

2.3

0.5

2.1

701(e)(1)(A)(ii) - By Issuer only pursuant to agreement (Non COBRA Covered)

0.2

0.0

0.0

0.0

701(e)(1)(A)(iii) - Upon request

2.6

2.8

1.9

2.8

701(e)(1)(A)(iii) - By Plan (Upon Request)

1.6

2.5

1.9

2.5

701(e)(1)(A)(iii) - By Issuer only pursuant to agreement (Upon Request)

1.0

0.3

0.0

0.3

29 CFR 2590.701 - 5(a)(2) - Within required time frames

2.7

0.8

2.4

0.9

29 CFR 2590.701 - 5(a)(2) - By Plan (W/In Req'd Timeframes)

2.2

0.8

2.2

0.9

29 CFR 2590.701 - 5(a)(2) - By Issuer with agreement (W/In Req'd Timeframes)

0.5

0.0

0.2

0.0

Other - Failure to Provide Certificates

3.6

2.5

4.7

2.6

H3 - Special Enrollment Violation

10.9

16.2

15.5

15.9

701(f)(1) - Failure to allow special enrollment upon loss of other coverage

3.1

5.3

3.6

5.2

701(f)(2) - Failure to allow dependant special enrollment

2.1

3.0

3.1

3.0

29 CFR 2590.701-6(c) - Failure to give notice of special enrollment rights

7.8

12.4

12.3

12.1

Other - Special Enrollment Violation

1.5

1.5

0.5

1.5

H4 - Nondiscrimination Violation

13.2%

6.9%

23.0%

7.3%

702(a) - Nonconfinement clause that delays eligibility

9.2

4.6

17.7

4.9

702(a) - Other violation of eligibility discrimination provision

5.0

3.6

6.3

3.7

702(b) - Nonconfinement clause that raises premiums

0.0

0.0

0.0

0.0

702(b) - Other violation of premium discrimination provision

0.2

0.0

0.0

0.0

Other - Nondiscrimination Violation

1.9

0.3

1.0

.04

H5 - 701(g) - HMO Affiliation Period Violation

0.0

0.0

0.0

0.0

H6 - 703 - MEWA or Multiemployer Plan Failure to Provide Guaranteed Renewability

0.0

0.0

0.0

0.0

700.2 - Mental Health Parity Act Violations

8.0

7.9

19.9

8.0

Not Subject to Mental Health Parity Act

10.9

84.0

5.1

78.8

Mental Health Parity Act Violation

8.0

7.9

19.9

8.0

M1 - 712(a)(1) - Lifetime Dollar Limit

4.1

3.2

6.1

3.5

M2 - 712(a)(1) - Constructive (Straight math) Lifetime Dollar Limit

0.5

1.6

1.3

1.3

M3 - 712(a)(2) - Annual Dollar Limit

4.1

4.8

6.4

4.6

M4 - 712(a)(2) - Constructive (Straight math) Annual Dollar Limit

2.6

4.8

10.7

4.2

M5 - 29 CFR 2590.712(b)(4) - Substance Abuse Offsets Mental Health Limit

1.6

4.8

2.5

3.8

M6 - Other

0.5

0.0

0.0

0.2

700.3 - Newborns' and Mothers' Health Protection Act Violations

18.9

36.9

21.4

35.0

Not Subject to Newborns' and Mothers' Health Protection Act

57.1

71.8

25.6

70.7

Newborns' and Mothers' Health Protection Act Violations

18.9

36.9

21.4

35.0

N1 - 711(a)(1)(A) - Violation of 48/96 Hour Stay Rule

1.6

3.6

1.3

3.4

N2 - 711(a)(1)(B) - Provider Required to Obtain Authorization From Plan

1.7

2.7

1.6

2.6

N3 - 711(b) - Incentives to Mothers or Doctors

0.0

0.9

0.6

0.8

N4 - 711(d) - Notice Violation

17.8

34.2

20.8

32.5

N5 - Other

0.0

0.0

0.0

0.0

700.4 - Women's Health and Cancer Rights Act Violations

18.5

22.1

17.2

21.8

Not Subject to Women's Health and Cancer Rights Act

0.9

1.5

0.7

1.5

Women's Health and Cancer Rights Act Violations

18.5

22.1

17.2

21.8

W1 - 713(a) - Not Providing the Three Required Coverages

3.1

3.3

2.4

3.3

W2 - 713(a) - Annual Enrollment Notice Violation

13.3

18.0

10.6

17.7

W3 - 713(b) - One-Time Notice Violation

8.4

8.9

8.5

8.8

W4 - 713(c) - Incentive Problem

0.0

0.0

0.0

0.0

W5 - Other

0.8

1.3

1.9

1.2

Average Number of Part VII Violations per Case

1.6

1.5

2.2

1.5

Table 7.  Detailed Substantive Violation Rates by Sample (Excluding Notice Requirements)
(Weighted Violation Rates)

Violation

Large

Small

Multi

All

700 - Part 7 Provisions

37.2%

30.2%

51.7%

30.7%

700.1 - HIPAA Violations

33.0

27.7

44.4

28.1

H1 - Impermissible preexisting condition exclusion

20.4

18.3

28.0

18.4

701(a)(1) - 6-Month look-back violation

12.3

11.7

17.2

11.7

701(a)(1) [using 701(b)(1) definition] - Preex on genetic information

0.0

0.5

1.0

0.5

701(a)(2) - 12 Month (or 18 month) look-forward violation

10.4

9.4

18.4

9.5

701(a)(3) [using 701(c) definition] - Failure to offset

6.4

6.3

9.7

6.4

701(d)(1) - Impermissible preex on newborns

1.2

0.5

4.6

0.6

701(d)(2) - Impermissible preex on children adopted or placed for adoption

1.3

0.8

4.4

0.8

701(d)(3) - Pregnancy preex

1.4

3.3

5.1

3.2

Other - Impermissible preex

6.5

4.8

6.6

4.9

H2 - Failure to Provide Certificates

9.5

7.1

11.5

7.3

701(e)(1)(A)(i) - Automatically upon loss of coverage (COBRA covered plan)

4.0

0.8

5.6

1.0

701(e)(1)(A)(i) - By Plan (COBRA Covered)

3.0

0.8

5.3

0.9

701(e)(1)(A)(i) - By Issuer only pursuant to agreement (COBRA Covered)

1.0

0.0

0.2

0.1

701(e)(1)(A)(ii) - Automatically upon loss of coverage (Non COBRA Covered)

0.5

2.3

0.5

2.2

701(e)(1)(A)(ii) - By Plan (Non COBRA Covered)

0.2

2.3

0.5

2.1

701(e)(1)(A)(ii) - By Issuer only pursuant to agreement (Non COBRA Covered)

0.2

0.0

0.0

0.0

701(e)(1)(A)(iii) - Upon request

2.6

2.8

1.9

2.8

701(e)(1)(A)(iii) - By Plan (Upon Request)

1.6

2.5

1.9

2.5

701(e)(1)(A)(iii) - By Issuer only pursuant to agreement (Upon Request)

1.0

0.3

0.0

0.3

29 CFR 2590.701 - 5(a)(2) - Within required time frames

2.7

0.8

2.4

0.9

29 CFR 2590.701 - 5(a)(2) - By Plan (W/In Req'd Timeframes)

2.2

0.8

2.2

0.9

29 CFR 2590.701 - 5(a)(2) - By Issuer with agreement (W/In Req'd Timeframes)

0.5

0.0

0.2

0.0

Other - Failure to Provide Certificates

3.6

2.5

4.7

2.6

H3 - Special Enrollment Violation

5.3

7.4

5.6

7.2

701(f)(1) - Failure to allow special enrollment upon loss of other coverage

3.1

5.3

3.6

5.2

701(f)(2) - Failure to allow dependant special enrollment

2.1

3.0

3.1

3.0

Other - Special Enrollment Violation

1.5

1.5

0.5

1.5

H4 - Nondiscrimination Violation

13.2

6.9

23.0

7.3

702(a) - Nonconfinement clause that delays eligibility

9.2

4.6

17.7

4.9

702(a) - Other violation of eligibility discrimination provision

5.0

3.6

6.3

3.7

702(b) - Nonconfinement clause that raises premiums

0.0%

0.0%

0.0%

0.0%

702(b) - Other violation of premium discrimination provision

0.2

0.0

0.0

0.0

Other - Nondiscrimination Violation

1.9

0.3

1.0

0.4

H5 - 701(g) - HMO Affiliation Period Violation

0.0

0.0

0.0

0.0

H6 - 703 - MEWA or Multiemployer Plan Failure to Provide Guaranteed Renewability

0.0

0.0

0.0

0.0

700.2 - Mental Health Parity Act Violations

8.0

7.9

19.9

8.0

Not Subject to Mental Health Parity Act

10.9

84.0

5.1

78.8

Mental Health Parity Act Violation

8.0

7.9

19.9

8.0

M1 - 712(a)(1) - Lifetime Dollar Limit

4.1

3.2

6.1

3.5

M2 - 712(a)(1) - Constructive (Straight math) Lifetime Dollar Limit

0.5

1.6

1.3

1.3

M3 - 712(a)(2) - Annual Dollar Limit

4.1

4.8

6.4

4.6

M4 - 712(a)(2) - Constructive (Straight math) Annual Dollar Limit

2.6

4.8

10.7

4.2

M5 - 29 CFR 2590.712(b)(4) - Substance Abuse Offsets Mental Health Limit

1.6

4.8

2.5

3.8

M6 - Other

0.5

0.0

0.0

0.2

700.3 - Newborns' and Mothers' Health Protection Act Violations

3.3

5.4

2.9

5.2

Not Subject to Newborns' and Mothers' Health Protection Act

57.1

71.8

25.6

70.7

Newborns' and Mothers' Health Protection Act Violations

3.3

5.4

2.9

5.2

N1 - 711(a)(1)(A) - Violation of 48/96 Hour Stay Rule

1.6

3.6

1.3

3.4

N2 - 711(a)(1)(B) - Provider Required to Obtain Authorization From Plan

1.7

2.7

1.6

2.6

N3 - 711(b) - Incentives to Mothers or Doctors

0.0

0.9

0.6

0.8

N5 - Other

0.0

0.0

0.0

0.0

700.4 - Women's Health and Cancer Rights Act Violations

4.0

4.6

4.4

4.5

Not Subject to Women's Health and Cancer Rights Act

0.9

1.5

0.7

1.5

Women's Health and Cancer Rights Act Violations

4.0

4.6

4.4

4.5

W1 - 713(a) - Not Providing the Three Required Coverages

3.1

3.3

2.4

3.3

W4 - 713(c) - Incentive Problem

0.0

0.0

0.0

0.0

W5 - Other

0.8

1.3

1.9

1.2

Average Number of Part 7 Violations per Case

0.9

0.7

1.5

0.8

Table 8A.  Part 7 Violations by Decreasing Prevalence
(Weighted Violation Rates)
Sample=Large

Statute

Violation

Rate

NMHPA

N4 - 711(d) - Notice Violation

17.8%

HIPAA-H1 (Preex)

29 CFR 2590.701-3(c) - Failure to give adequate generalized notices of preex

15.5

WHCRA

W2 - 713(a) - Annual Enrollment Notice Violation

13.3

HIPAA-H1 (Preex)

701(a)(1) - 6-Month look-back violation

12.3

HIPAA-H1 (Preex)

29 CFR 2590.701-5(d) - Failure to give adequate individualized notices of preex

11.7

HIPAA-H1 (Preex)

701(a)(2) - 12 Month (or 18 month) look-forward violation

10.4

HIPAA-H4 (Nondiscrim)

702(a) - Nonconfinement clause that delays eligibility

9.2

WHCRA

W3 - 713(b) - One-Time Notice Violation

8.4

HIPAA-H3 (Sp Enroll)

29 CFR 2590.701-6(c) - Failure to give notice of special enrollment rights

7.8

HIPAA-H1 (Preex)

Other - Impermissible preex

6.5

HIPAA-H1 (Preex)

701(a)(3) [using 701(c) definition] - Failure to offset

6.4

HIPAA-H4 (Nondiscrim)

702(a) - Other violation of eligibility discrimination provision

5.0

MHPA

M1 - 712(a)(1) - Lifetime Dollar Limit

4.1

MHPA

M3 - 712(a)(2) - Annual Dollar Limit

4.1

HIPAA-H2 (Certif)

Other - Failure to Provide Certificates

3.6

HIPAA-H3 (Sp Enroll)

701(f)(1) - Failure to allow special enrollment upon loss of other coverage

3.1

WHCRA

W1 - 713(a) - Not Providing the Three Required Coverages

3.1

HIPAA-H2 (Certif)

701(e)(1)(A)(i) - By Plan (COBRA Covered)

3.0

MHPA

M4 - 712(a)(2) - Constructive (Straight math) Annual Dollar Limit

2.6

HIPAA-H2 (Certif)

29 CFR 2590.701 - 5(a)(2) - By Plan (W/In Req'd Timeframes)

2.2

HIPAA-H3 (Sp Enroll)

701(f)(2) - Failure to allow dependant special enrollment

2.1

HIPAA-H4 (Nondiscrim)

Other - Nondiscrimination Violation

1.9

NMHPA

N2 - 711(a)(1)(B) - Provider Required to Obtain Authorization From Plan

1.7

NMHPA

N1 - 711(a)(1)(A) - Violation of 48/96 Hour Stay Rule

1.6

MHPA

M5 - 29 CFR 2590.712(b)(4) - Substance Abuse Offsets Mental Health Limit

1.6

HIPAA-H2 (Certif)

701(e)(1)(A)(iii) - By Plan (Upon Request)

1.6

HIPAA-H3 (Sp Enroll)

Other - Special Enrollment Violation

1.5

HIPAA-H1 (Preex)

701(d)(3) - Pregnancy preex

1.4

HIPAA-H1 (Preex)

701(d)(2) - Impermissible preex on children adopted or placed for adoption

1.3

HIPAA-H1 (Preex)

701(d)(1) - Impermissible preex on newborns

1.2

HIPAA-H2 (Certif)

701(e)(1)(A)(i) - By Issuer only pursuant to agreement (COBRA Covered)

1.0

HIPAA-H2 (Certif)

701(e)(1)(A)(iii) - By Issuer only pursuant to agreement (Upon Request)

1.0

WHCRA

W5 - Other

0.8

MHPA

M2 - 712(a)(1) - Constructive (Straight math) Lifetime Dollar Limit

0.5

MHPA

M6 - Other

0.5

HIPAA-H2 (Certif)

29 CFR 2590.701 - 5(a)(2) - By Issuer with agreement (W/In Req'd Timeframes)

0.5

HIPAA-H2 (Certif)

701(e)(1)(A)(ii) - By Plan (Non COBRA Covered)

0.2

HIPAA-H2 (Certif)

701(e)(1)(A)(ii) - By Issuer only pursuant to agreement (Non COBRA Covered)

0.2

HIPAA-H4 (Nondiscrim)

702(b) - Other violation of premium discrimination provision

0.2

HIPAA-H1 (Preex)

701(a)(1) [using 701(b)(1) definition] - Preex on genetic information

0.0

HIPAA-H4 (Nondiscrim)

702(b) - Nonconfinement clause that raises premiums

0.0

HIPAA-H5

H5 - 701(g) - HMO Affiliation Period Violation

0.0

HIPAA-H6

H6 - 703 - MEWA or Multiemployer Plan Failure to Provide Guaranteed Renewability

0.0

NMHPA

N3 - 711(b) - Incentives to Mothers or Doctors

0.0

NMHPA

N5 - Other

0.0

WHCRA

W4 - 713(c) - Incentive Problem

0.0

Table 8B.  Part 7 Violations by Decreasing Prevalence
(Weighted Violation Rates)
Sample=Small

Statute

Violation

Rate

NMHPA

N4 - 711(d) - Notice Violation

34.2%

WHCRA

W2 - 713(a) - Annual Enrollment Notice Violation

18.0

HIPAA-H1 (Preex)

29 CFR 2590.701-3(c) - Failure to give adequate generalized notices of preex

14.5

HIPAA-H3 (Sp Enroll)

29 CFR 2590.701-6(c) - Failure to give notice of special enrollment rights

12.4

HIPAA-H1 (Preex)

701(a)(1) - 6-Month look-back violation

11.7

HIPAA-H1 (Preex)

29 CFR 2590.701-5(d) - Failure to give adequate individualized notices of preex

10.4

HIPAA-H1 (Preex)

701(a)(2) - 12 Month (or 18 month) look-forward violation

9.4

WHCRA

W3 - 713(b) - One-Time Notice Violation

8.9

HIPAA-H1 (Preex)

701(a)(3) [using 701(c) definition] - Failure to offset

6.3

HIPAA-H3 (Sp Enroll)

701(f)(1) - Failure to allow special enrollment upon loss of other coverage

5.3

HIPAA-H1 (Preex)

Other - Impermissible preex

4.8

MHPA

M3 - 712(a)(2) - Annual Dollar Limit

4.8

MHPA

M4 - 712(a)(2) - Constructive (Straight math) Annual Dollar Limit

4.8

MHPA

M5 - 29 CFR 2590.712(b)(4) - Substance Abuse Offsets Mental Health Limit

4.8

HIPAA-H4 (Nondiscrim)

702(a) - Nonconfinement clause that delays eligibility

4.6

NMHPA

N1 - 711(a)(1)(A) - Violation of 48/96 Hour Stay Rule

3.6

HIPAA-H4 (Nondiscrim)

702(a) - Other violation of eligibility discrimination provision

3.6

HIPAA-H1 (Preex)

701(d)(3) - Pregnancy preex

3.3

WHCRA

W1 - 713(a) - Not Providing the Three Required Coverages

3.3

MHPA

M1 - 712(a)(1) - Lifetime Dollar Limit

3.2

HIPAA-H3 (Sp Enroll)

701(f)(2) - Failure to allow dependant special enrollment

3.0

NMHPA

N2 - 711(a)(1)(B) - Provider Required to Obtain Authorization From Plan

2.7

HIPAA-H2 (Certif)

701(e)(1)(A)(iii) - By Plan (Upon Request)

2.5

HIPAA-H2 (Certif)

Other - Failure to Provide Certificates

2.5

HIPAA-H2 (Certif)

701(e)(1)(A)(ii) - By Plan (Non COBRA Covered)

2.3

MHPA

M2 - 712(a)(1) - Constructive (Straight math) Lifetime Dollar Limit

1.6

HIPAA-H3 (Sp Enroll)

Other - Special Enrollment Violation

1.5

WHCRA

W5 - Other

1.3

NMHPA

N3 - 711(b) - Incentives to Mothers or Doctors

0.9

HIPAA-H1 (Preex)

701(d)(2) - Impermissible preex on children adopted or placed for adoption

0.8

HIPAA-H2 (Certif)

701(e)(1)(A)(i) - By Plan (COBRA Covered)

0.8

HIPAA-H2 (Certif)

29 CFR 2590.701 - 5(a)(2) - By Plan (W/In Req'd Timeframes)

0.8

HIPAA-H1 (Preex)

701(a)(1) [using 701(b)(1) definition] - Preex on genetic information

0.5

HIPAA-H1 (Preex)

701(d)(1) - Impermissible preex on newborns

0.5

HIPAA-H2 (Certif)

701(e)(1)(A)(iii) - By Issuer only pursuant to agreement (Upon Request)

0.3

HIPAA-H4 (Nondiscrim)

Other - Nondiscrimination Violation

0.3

HIPAA-H2 (Certif)

701(e)(1)(A)(i) - By Issuer only pursuant to agreement (COBRA Covered)

0.0

HIPAA-H2 (Certif)

701(e)(1)(A)(ii) - By Issuer only pursuant to agreement (Non COBRA Covered)

0.0

HIPAA-H2 (Certif)

29 CFR 2590.701 - 5(a)(2) - By Issuer with agreement (W/In Req'd Timeframes)

0.0

HIPAA-H4 (Nondiscrim)

702(b) - Nonconfinement clause that raises premiums

0.0

HIPAA-H4 (Nondiscrim)

702(b) - Other violation of premium discrimination provision

0.0

HIPAA-H5

H5 - 701(g) - HMO Affiliation Period Violation

0.0

HIPAA-H6

H6 - 703 - MEWA or Multiemployer Plan Failure to Provide Guaranteed Renewability

0.0

MHPA

M6 - Other

0.0

NMHPA

N5 - Other

0.0

WHCRA

W4 - 713(c) - Incentive Problem

0.0

Table 8C.  Part 7 Violations by Decreasing Prevalence
(Weighted Violation Rates)
Sample=Multi

Statute

Violation

Rate

NMHPA

N4 - 711(d) - Notice Violation

20.8%

HIPAA-H1 (Preex)

29 CFR 2590.701-3(c) - Failure to give adequate generalized notices of preex

18.6

HIPAA-H1 (Preex)

701(a)(2) - 12 Month (or 18 month) look-forward violation

18.4

HIPAA-H4 (Nondiscrim)

702(a) - Nonconfinement clause that delays eligibility

17.7

HIPAA-H1 (Preex)

701(a)(1) - 6-Month look-back violation

17.2

HIPAA-H3 (Sp Enroll)

29 CFR 2590.701-6(c) - Failure to give notice of special enrollment rights

12.3

HIPAA-H1 (Preex)

29 CFR 2590.701-5(d) - Failure to give adequate individualized notices of preex

10.9

MHPA

M4 - 712(a)(2) - Constructive (Straight math) Annual Dollar Limit

10.7

WHCRA

W2 - 713(a) - Annual Enrollment Notice Violation

10.6

HIPAA-H1 (Preex)

701(a)(3) [using 701(c) definition] - Failure to offset

9.7

WHCRA

W3 - 713(b) - One-Time Notice Violation

8.5

HIPAA-H1 (Preex)

Other - Impermissible preex

6.6

MHPA

M3 - 712(a)(2) - Annual Dollar Limit

6.4

HIPAA-H4 (Nondiscrim)

702(a) - Other violation of eligibility discrimination provision

6.3

MHPA

M1 - 712(a)(1) - Lifetime Dollar Limit

6.1

HIPAA-H2 (Certif)

701(e)(1)(A)(i) - By Plan (COBRA Covered)

5.3

HIPAA-H1 (Preex)

701(d)(3) - Pregnancy preex

5.1

HIPAA-H2 (Certif)

Other - Failure to Provide Certificates

4.7

HIPAA-H1 (Preex)

701(d)(1) - Impermissible preex on newborns

4.6

HIPAA-H1 (Preex)

701(d)(2) - Impermissible preex on children adopted or placed for adoption

4.4

HIPAA-H3 (Sp Enroll)

701(f)(1) - Failure to allow special enrollment upon loss of other coverage

3.6

HIPAA-H3 (Sp Enroll)

701(f)(2) - Failure to allow dependant special enrollment

3.1

MHPA

M5 - 29 CFR 2590.712(b)(4) - Substance Abuse Offsets Mental Health Limit

2.5

WHCRA

W1 - 713(a) - Not Providing the Three Required Coverages

2.4

HIPAA-H2 (Certif)

29 CFR 2590.701 - 5(a)(2) - By Plan (W/In Req'd Timeframes)

2.2

HIPAA-H2 (Certif)

701(e)(1)(A)(iii) - By Plan (Upon Request)

1.9

WHCRA

W5 - Other

1.9

NMHPA

N2 - 711(a)(1)(B) - Provider Required to Obtain Authorization From Plan

1.6

NMHPA

N1 - 711(a)(1)(A) - Violation of 48/96 Hour Stay Rule

1.3

MHPA

M2 - 712(a)(1) - Constructive (Straight math) Lifetime Dollar Limit

1.3

HIPAA-H1 (Preex)

701(a)(1) [using 701(b)(1) definition] - Preex on genetic information

1.0

HIPAA-H4 (Nondiscrim)

Other - Nondiscrimination Violation

1.0

NMHPA

N3 - 711(b) - Incentives to Mothers or Doctors

0.6

HIPAA-H2 (Certif)

701(e)(1)(A)(ii) - By Plan (Non COBRA Covered)

0.5

HIPAA-H3 (Sp Enroll)

Other - Special Enrollment Violation

0.5

HIPAA-H2 (Certif)

701(e)(1)(A)(i) - By Issuer only pursuant to agreement (COBRA Covered)

0.2

HIPAA-H2 (Certif)

29 CFR 2590.701 - 5(a)(2) - By Issuer with agreement (W/In Req'd Timeframes)

0.2

HIPAA-H2 (Certif)

701(e)(1)(A)(ii) - By Issuer only pursuant to agreement (Non COBRA Covered)

0.0

HIPAA-H2 (Certif)

701(e)(1)(A)(iii) - By Issuer only pursuant to agreement (Upon Request)

0.0

HIPAA-H4 (Nondiscrim)

702(b) - Nonconfinement clause that raises premiums

0.0

HIPAA-H4 (Nondiscrim)

702(b) - Other violation of premium discrimination provision

0.0

HIPAA-H5

H5 - 701(g) - HMO Affiliation Period Violation

0.0

HIPAA-H6

H6 - 703 - MEWA or Multiemployer Plan Failure to Provide Guaranteed Renewability

0.0

MHPA

M6 - Other

0.0

NMHPA

N5 - Other

0.0

WHCRA

W4 - 713(c) - Incentive Problem

0.0

Table 9. The 40 Pairs of Violations Having the Highest Correlations
Unweighted Correlations from All Three Samples Pooled

First Violation

Second Violation

Correlation

HIPAA-H1 (Preex)-Look-fwd

HIPAA-H1 (Preex)-Look-back

0.796

HIPAA-H1 (Preex)-Ind. notices

HIPAA-H1 (Preex)-Gen. notices

0.689

HIPAA-H1 (Preex)-Adoption

HIPAA-H1 (Preex)-Newborns

0.648

HIPAA-H1 (Preex)-No offset

HIPAA-H1 (Preex)-Look-fwd

0.639

HIPAA-H1 (Preex)-No offset

HIPAA-H1 (Preex)-Look-back

0.623

HIPAA-H2 (Certif)-Time-I

HIPAA-H2 (Certif)-Auto-C-I

0.611

MHPA-M3 (Annual limit)

MHPA-M1 (Life limit)

0.601

HIPAA-H1 (Preex)-Gen. notices

HIPAA-H1 (Preex)-Look-back

0.516

HIPAA-H1 (Preex)-Gen. notices

HIPAA-H1 (Preex)-Look-fwd

0.504

HIPAA-H3 (Sp Enroll)-Dependent

HIPAA-H3 (Sp Enroll)-Cov loss

0.478

HIPAA-H1 (Preex)-Ind. notices

HIPAA-H1 (Preex)-Look-fwd

0.461

HIPAA-H1 (Preex)-Ind. notices

HIPAA-H1 (Preex)-No offset

0.460

HIPAA-H1 (Preex)-Ind. notices

HIPAA-H1 (Preex)-Look-back

0.455

MHPA-M5 (Subst abuse offset)

MHPA-M1 (Life limit)

0.425

HIPAA-H1 (Preex)-Gen. notices

HIPAA-H1 (Preex)-No offset

0.416

HIPAA-H2 (Certif)-Auto-NC-I

HIPAA-H2 (Certif)-Auto-C-I

0.407

HIPAA-H2 (Certif)-Time-I

HIPAA-H2 (Certif)-Req-I

0.406

WHCRA-W2 (Annual notice)

WHCRA-W3 (One-time notice)

0.397

MHPA-M5 (Subst abuse offset)

MHPA-M3 (Annual limit)

0.350

HIPAA-H2 (Certif)-Req-P

HIPAA-H2 (Certif)-Auto-NC-P

0.331

HIPAA-H2 (Certif)-Req-I

HIPAA-H2 (Certif)-Auto-C-I

0.330

NMHPA-N2 (Plan authoriz)

NMHPA-N3 (Doc/mom incent)

0.328

HIPAA-H2 (Certif)-Time-P

HIPAA-H2 (Certif)-Auto-C-P

0.326

WHCRA-W1 (Missing cov)

NMHPA-N1 (48/96 hour rule)

0.322

HIPAA-H3 (Sp Enroll)-No notice

HIPAA-H3 (Sp Enroll)-Cov loss

0.303

HIPAA-H2 (Certif)-Req-I

NMHPA-N1 (48/96 hour rule)

0.299

HIPAA-H1 (Preex)-Adoption

HIPAA-H1 (Preex)-Look-back

0.273

HIPAA-H3 (Sp Enroll)-No notice

HIPAA-H3 (Sp Enroll)-Dependent

0.272

NMHPA-N4 (Notice viol)

HIPAA-H3 (Sp Enroll)-No notice

0.269

HIPAA-H1 (Preex)-Adoption

HIPAA-H1 (Preex)-Look-fwd

0.268

HIPAA-H1 (Preex)-Adoption

HIPAA-H1 (Preex)-No offset

0.252

WHCRA-W2 (Annual notice)

WHCRA-W1 (Missing cov)

0.252

HIPAA-H2 (Certif)-Time-P

HIPAA-H2 (Certif)-Req-P

0.237

WHCRA-W1 (Missing cov)

NMHPA-N4 (Notice viol)

0.234

WHCRA-W2 (Annual notice)

NMHPA-N4 (Notice viol)

0.232

HIPAA-H1 (Preex)-Genetic

HIPAA-H1 (Preex)-Pregnancy

0.230

HIPAA-H1 (Preex)-Newborns

HIPAA-H1 (Preex)-Pregnancy

0.229

NMHPA-N1 (48/96 hour rule)

HIPAA-H3 (Sp Enroll)-Cov loss

0.218

MHPA-M3 (Annual limit)

HIPAA-H1 (Preex)-Gen. notices

0.217

NMHPA-N1 (48/96 hour rule)

HIPAA-H3 (Sp Enroll)-Other

0.217

Table 10.  Meaning of Short Violation Names

Short Violation Name

Long Violation Name

700 - Part 7 Provisions

700.1 - HIPAA Violations

H1 - Impermissible preexisting condition exclusion

HIPAA-H1 (Preex)-Look-back

701(a)(1) - 6-Month look-back violation

HIPAA-H1 (Preex)-Genetic

701(a)(1) [using 701(b)(1) definition] - Preex on genetic information

HIPAA-H1 (Preex)-Look-fwd

701(a)(2) - 12 Month (or 18 month) look-forward violation

HIPAA-H1 (Preex)-No offset

701(a)(3) [using 701(c) definition] - Failure to offset

HIPAA-H1 (Preex)-Newborns

701(d)(1) - Impermissible preex on newborns

HIPAA-H1 (Preex)-Adoption

701(d)(2) - Impermissible preex on children adopted or placed for adoption

HIPAA-H1 (Preex)-Pregnancy

701(d)(3) - Pregnancy preex

HIPAA-H1 (Preex)-Gen. notices

29CFR 2590.701-3(c) - Failure to give adequate generalized notices of preex

HIPAA-H1 (Preex)-Ind. notices

29CFR 2590.701-5(d) - Failure to give adequate individualized notices of preex

HIPAA-H1 (Preex)-Other

Other - Impermissible preex

H2 - Failure to Provide Certificates

701(e)(1)(A)(i) - Automatically upon loss of coverage (COBRA covered plan)

HIPAA-H2 (Certif)-Auto-C-P

701(e)(1)(A)(i) - By Plan (COBRA Covered)

HIPAA-H2 (Certif)-Auto-C-I

701(e)(1)(A)(i) - By Issuer only pursuant to agreement (COBRA Covered)

701(e)(1)(A)(ii) - Automatically upon loss of coverage (Non COBRA covered)

HIPAA-H2 (Certif)-Auto-NC-P

701(e)(1)(A)(ii) - By Plan (Non COBRA Covered)

HIPAA-H2 (Certif)-Auto-NC-I

701(e)(1)(A)(ii) - By Issuer only pursuant to agreement (Non COBRA Covered)

701(e)(1)(A)(iii) - Upon request

HIPAA-H2 (Certif)-Req-P

701(e)(1)(A)(iii) - By Plan (Upon Request)

HIPAA-H2 (Certif)-Req-I

701(e)(1)(A)(iii) - By Issuer only pursuant to agreement (Upon Request)

29 CFR 2590.701 - 5(a)(2) - Within required time frames

HIPAA-H2 (Certif)-Time-P

29 CFR 2590.701 - 5(a)(2) - By Plan (W/In Req'd Timeframes)

HIPAA-H2 (Certif)-Time-I

29 CFR 2590.701 - 5(a)(2) - By Issuer with agreement (W/In Req'd Timeframes)

HIPAA-H2 (Certif)-Other

Other - Failure to Provide Certificates

H3 - Special Enrollment Violation

HIPAA-H3 (Sp Enroll)-Cov loss

701(f)(1) - Failure to allow special enrollment upon loss of other coverage

HIPAA-H3 (Sp Enroll)-Dependent

701(f)(2) - Failure to allow dependant special enrollment

HIPAA-H3 (Sp Enroll)-No notice

29 CFR 2590.701-6(c) - Failure to give notice of special enrollment rights

HIPAA-H3 (Sp Enroll)-Other

Other - Special Enrollment Violation

H4 - Nondiscrimination Violation

HIPAA-H4 (Non-dscrm)-Ncfmnt

702(a) - Nonconfinement clause that delays eligibility

HIPAA-H4 (Non-dscrm)-Other elig

702(a) - Other violation of eligibility discrimination provision

HIPAA-H4 (Non-dscrm)-Ncfmnt-prem

702(b) - Nonconfinement clause that raises premiums

HIPAA-H4 (Non-dscrm)-Other prem

702(b) - Other violation of premium discrimination provision

HIPAA-H4 (Non-dscrm)-Other

Other - Nondiscrimination Violation

HIPAA-H5 (HMO Affil Period)

H5 - 701(g) - HMO Affiliation Period Violation

HIPAA-H6 (Multi No renew)

H6 - 703 - MEWA or Multiemployer Plan Failure to Provide Guaranteed Renewability

700.2 - Mental Health Parity Act Violations

Not Subject to Mental Health Parity Act

Mental Health Parity Act Violation

MHPA-M1 (Life limit)

M1 - 712(a)(1) - Lifetime Dollar Limit

MHPA-M2 (Constr life Limit)

M2 - 712(a)(1) - Constructive (Straight math) Lifetime Dollar Limit

MHPA-M3 (Annual limit)

M3 - 712(a)(2) - Annual Dollar Limit

MHPA-M4 (Constr annual Lim)

M4 - 712(a)(2) - Constructive (Straight math) Annual Dollar Limit

MHPA-M5 (Subst abuse offset)

M5 - 29 CFR 2590.712(b)(4) - Substance Abuse Offsets Mental Health Limit

MHPA-M6 (Other)

M6 - Other

700.3 - Newborns’ and Mothers’ Health Protection Act Violations

Not Subject to Newborns’ and Mothers’ Health Protection Act

Newborns’ and Mothers’ Health Protection Act Violations

NMHPA-N1 (48/96 hour rule)

N1 - 711(a)(1)(A) - Violation of 48/96 Hour Stay Rule

NMHPA-N2 (Plan authoriz)

N2 - 711(a)(1)(B) - Provider Required to Obtain Authorization From Plan

NMHPA-N3 (Doc/mom incent)

N3 - 711(b) - Incentives to Mothers or Doctors

NMHPA-N4 (Notice viol)

N4 - 711(d) - Notice Violation

NMHPA-N5 (Other)

N5 - Other

700.4 - Women's Health and Cancer Rights Act Violations

Not Subject to Women's Health and Cancer Rights Act

Women's Health and Cancer Rights Act Violation

WHCRA-W1 (Missing cov)

W1 - 713(a) - Not Providing the Three Required Coverages

WHCRA-W2 (Annual notice)

W2 - 713(a) - Annual Enrollment Notice Violation

WHCRA-W3 (One-time notice)

W3 - 713(b) - One-Time Notice Violation

WHCRA-W4 (Incentive prob)

W4 - 713(c) - Incentive Problem

WHCRA-W5 (Other)

W5 - Other