RE: Disclosing Claims Info to Fully-Insured Group Moving to Self- Fund ed

[Traci.Jensen]

Title: Disclosing Claims Info to Fully-Insured Group Moving to Self-Funded

Problem is that the group would need the claims experience (full PHI) at the time of their renewal or right when they are switching from fully-insured to self-funded.  It is more than likely that the group would not have their plan documents amended yet.  Our organization is thinking that we could supply the information to the stop-loss carrier directly and bypass the group.  Any thoughts on this?      -----Original Message----- From: Deborah Campbell [mailto:[EMAIL PROTECTED] Sent: Monday, March 24, 2003 12:05 PM To: WEDI SNIP Privacy Workgroup List Subject: RE: Disclosing Claims Info to Fully-Insured Group Moving to Self- Fund ed I agree. Any plan has the right to amend their plan documents to obtain this information. I was only trying to answer the question, how can we give the GHP this information. (A GHP can be either self-insured or fully-insured). And the answer is, have them certify they have amended their plan documents.  At least, I believe that is the answer. Deborah -----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 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] ******************************************* The information in this email is confidential and may be legally privileged.  It is intended solely for the addressee.  Access to this email by anyone else is unauthorized. If you are not the intended recipient, any disclosure, copying, distribution or any action taken or omitted to be taken in reliance on it is prohibited and may be unlawful. ********************************************************************* -----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 This 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. --- 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] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- 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] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- 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] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- 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] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- 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] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org