Once they have certified that they have
made the appropriate changes, it doesn't matter if they are self-funded
or fully 0nsured. HIPAA states that as a plan sponsor, they have needs for the
information even if they are fully insured.
Karen H.
White
Vice President
Medstat
-----Original Message-----
From: Deborah Campbell
[mailto:[EMAIL PROTECTED]
Sent: Monday, March
24, 2003 12:02 PM
To: WEDI SNIP
Privacy Workgroup List
Subject: RE: Disclosing Claims
Info to Fully-Insured Group Moving to Self- Fund ed
According to what I know
about this, you would only be able to provide this type of information to the GHP
if they certified to you that they amended their plan documents. But, I might
be missing something.
Deborah
Campbell
Compliance Coordinator
Dominion
Dental Services, Inc.
115 South Union Street, Suite
300
Alexandria, Virginia 22314
Phn:
(703) 518-5000 ext. 3035
Fax: (703) 518-8849
Toll Free: 888-518-5338
Email: [EMAIL PROTECTED]
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-----Original
Message-----
From: Traci.Jensen
[mailto:[EMAIL PROTECTED]
Sent: Monday, March
24, 2003 11:58 AM
To: WEDI SNIP Privacy Workgroup
List
Subject: Disclosing Claims Info to
Fully-Insured Group Moving to Self-Fund ed
Pursuant to 164.530(k) a group health plan is not
subject to the Privacy standards if the group health plan provides health
benefits solely through an insurance contract with a health insurance issuer or
an HMO and the health insurane issuer or HMO with respect to the group health
plan only discloses eligibility, enrollment and disenrollment information and
summary information (claims information that doesn't identify a member) to an
employer group.
My two questions are:
If a
group health plan of an employer fall under the above definition
(fully-insured), however decides to become self-funded, would our organization
then be allowed to provide the claims experience by member to the employer in
order for them to send to the stop-loss carrier?
And, what if the employer is in the process to
determine if they want to become self-funded, would our organization be allowed
to provide the employer claims experience by member to the employer in order
for them to send to the stop-loss carrier?
Thank you in advance for your comments.
Traci
Jensen, CHC
Health Alliance Medical Plans, Inc.
Compliance Programs Manager
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participants, and do not necessarily represent the views of the WEDI Board of
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