Another issue that comes up a lot is the status of self-insured employers and TPAs.
The health plan definition includes employee plans with 50 plus participants OR where administered by another entity. (Text is below). This seems to cover most employee benefit plans, but the question persists. Perhaps it is due to the transactions standard comments about enrollment transactions where it states that sponsors (most often employers) aren't covered entities? While the employer isn't generally a covered entity, the employee welfare benefit plan is. Also, the privacy reg. addresses in several areas how to separate functions, etc. Do others see coverage for self-insured or TPA employee plans differently? Leah Hole-Curry Fox Systems, Inc. 602-708-1045 160.103 Text: A health plan includes among others, a group health plan. A Group health plan means an employee welfare benefit plan (as defined in section 3(1) of ERISA) including insured and self-insured plans to the extent that the plan provides medical care, including items and services paid for as medical care, to employees or their dependents directly or through insurance, reimbursement, or otherwise that: 1) has 50 or more participants as defined by ERISA OR 2) is administered by an entity other than the employer that established and maintains the plan. ********************************************************************** To be removed from this list, go to: http://snip.wedi.org/unsubscribe.cfm?list=privacy and enter your email address.
