All opinions expressed are my own and should not be construed to be Medical Mutual or Antares Management Solutions official policy.
Antares Management Solutions
23700 Commerce Park Road
Beachwood, Ohio 44122-5832
Phone: (216)292-1605
Fax: (216)292-1619
>>> "Deborah Campbell" <[EMAIL PROTECTED]> 03/24/03 01:05PM >>>
--------Original Message-----
From: White, Karen [mailto:[EMAIL PROTECTED]
Sent: Monday, March 24, 2003 12:53 PM
To: WEDI SNIP Privacy Workgroup List
Subject: RE: Disclosing Claims Info to Fully-Insured Group Moving to Self- Fund ed---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 CoordinatorDominion Dental Services, Inc.
115 South Union Street, Suite 300
Alexandria, Virginia 22314Phn: (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 edPursuant 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 ManagerThis electronic message contains information from Health Alliance Medical Plans, Inc. that may be confidential and/or privileged. This information is intended to be for the use of the individual(s) or entity(ies) named above. If you are not the intended recipient, be aware that copying, disclosure or distribution is strictly prohibited. If you have received this electronic transmission in error, please notify us by telephone at 800-851-3379, ext. 8012 or 4684 or by electronic mail to the sender immediately.
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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/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time.
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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/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time.
You are currently subscribed to wedi-privacy as: [EMAIL PROTECTED]
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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/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time.
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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/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time.
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