Dear Transactions Group: I was recently asked which employer sponsored group health plans should file for the transaction extension. The following is my analysis and a question. I would be very interested if the analysis is wrong and if you have an answer to the question.
1. An ERISA group health plan is a covered entity. 2. A plan meeting the small health plan definition should not file for an extension because there is no change in deadline and conceivably if they filed they might incur the April 2003 deadline to begin testing. They have nothing to gain by filing. 3. A plan that is not a small plan and that self-funds or self-insures all or part of the plan should file for the extension. It is dependent on its ASO or TPA processor; so it should take steps to ensure the processor will be compliant by the extended deadline. 4. But a plan that is not a small plan and that purchases all of its coverage from a health insurance company, is it really required to file in order to get the extension? My reading of the rules suggests that it is so required; however, since the insurance company is a covered entity and will be required either to meet the 2002 deadline or file an extension for itself, and because the group plan is wholly dependent upon the insurance company, it seems unnecessary to require the group plan to file. I would be interested in your thinking about "4" above. Thanks. Peter Peter Barry Peter T Barry Company Independent Consulting Health Care and Information Systems Ozaukee Bank Building 1425 West Mequon Road Mequon Wisconsin 53092 (414) 732 5000 (national cell) [EMAIL PROTECTED] --------------------------- 3. The health plan definition excludes plans that are both self-funded and self-administered. There are some but not many. Except, I have wondered if a TPA self-funds and administers the plan for its employees, is its plan excluded? I don't know and so far the issue is not become important to me. 4. So the plans you advise, and their need to file the extension by October 15, would appear to be: 4a. Small group health plans under $5 million definition do not gain anything by filing for the extension since they are not required to comply until October 2002 anyway. If they filed, there might be the downside to their filing in that they might now be expected to start testing in April 2003 whereas they are currently not so required. I think the filing would not trigger the testing deadline, but that would be a legal question of whether the filing or their small plan status determines. I see no advantage to their filing; so I would think it best that if a plan, as of this October, meets the small plan definition, it is better for it not file for an extension. 4b. Group health plans that do not meet the small plan definition: 4b(1). That only buys insurance and have no component that is self-funded or self-insured. These plans are dependent upon their health insurance company to comply. The law requires the health insurance company to comply. The only alternative for the group plan if the insurance company did not comply would be to change insurance companies. So it seems absurd to require these group plans to file for an extension. Yet I have so far found nothing except the absurdity that lets them off the hook. I will look into this more and hopefully come back to you next week. 4b(2). That self-funds or self-insures all or some part of the plan. These group plans must file for the extension. In the application they must say how to intend to comply and most will say they are depending upon an ASO or TPA administrator to do the work. So it would be prudent for them to get assurance from the ASO or TPA that they will comply and a good explanation of how. I think your company is in position to assist the plans in doing this, and it would be reasonable for the plans to assume you are planning to do so. Therefore, the priorities are: 1. Explain HIPAA, the deadlines, the need to extend, and Jabas's plans to assist to all clients. 2. Assist the group plans that are not small plans and that self-fund or self-insure some part of the plan to file the extension. 3. Meanwhile, I'll find out if the insured plans that are not self-funded still have to file the extension. Note that the extension applies only to moving the October 16, 2002, deadline for compliance with the Transactions and Code Sets rule one year to October 16, 2003. The filing adds a new deadline of April, 2003, to begin testing. The Privacy rule deadline is next April 2003 regardless of any of this. Peter Peter Barry Peter T Barry Company Independent Consulting Health Care and Information Systems Ozaukee Bank Building 1425 West Mequon Road Mequon Wisconsin 53092 (414) 732 5000 (national cell) [EMAIL PROTECTED] ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request. ====================================================== The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited.
