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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