Deborah, A health plan, as defined by HIPAA includes a list of 15 different types of entities plus a "catch-all category", and then some exceptions. Generally, health benefits offered by employers fall within the first type: "a group health plan" because they are employee welfare benefit plans that either 1) have 50 or more participants OR 2) are administered by an entity other than the employer, if not under this definition then type 8 is an employee welfare benefit plan or arrangement that offers health benefits to employees of two or more employers, or the catch-all "any other individual or group plan... that pays or provides the cost of medical care"
Other types of health plans under HIPAA include health insurance issuers (insurance companies or services licensed by a state), health maintenance organizations, Medicare and Medicaid programs, long term care policies, Federal employee and veterans health care programs, state child insurance plans, Indian health service programs. see official comments at page 82478 and 82507. So, yes, from your company name, you probably represent an insurance issuer or HMO and are a covered entity. Many of the entities that you sell insurance to (employee welfare benefit plans or group health plan) are also covered. Because employee welfare benefit plans are a separate entity from the employer, the employer itself is not covered, but the plan it sponsors is. Each of these plans must file an extension or authorize their administrator or another party to do so on their behalf. Karen Trudel of HHS,CMS recently affirmed this in response to a question (from BCBS, I think) on an audio-conference. Each plan may want to file for itself because it may have multiple insurance issuers, HMOS, TPAs or business associates that it does business with. Regarding whether a business associate relationship is created, you need to ask whether any of the functions your company performs under contract with these plans meets the BA definitions. Generally, though, health insurance issuers are not BAs of the plans that purchase from them. "Likewise, where a group health plan purchases insurance or coverage froma a health isnurance issuer or HMO, the provision of insuranceby the health insurance issuer or HMO does not make the issuer a business associate. In such case, the activities of the health insuranc issuer or HMOAS are on their own behalf and not on the behalf of the health plan. We note that where a group health plan contracts with ahealth insurance issuer or HMO to perform functions or activities or to provide services that are in addtion to or not directly related to the provision of insurance, the health insurance issuer or HMO may be a business associate with respoect to thos additional fucntions, activities, or services." Official comments, page 82476 Third party administrators, on the other hand, are most likely business associates. An example of a business associate TPA is found on page 82507. Regards, Leah Hole-Curry FOX Systems, Inc. 602.708.1045 Information transmitted is confidential and may be proprietary to FOX Systems, Inc. It is intended only for the person or entity to which it is addressed. Anyone else is prohibited from disclosing, copying, or disseminating the contents or attachments. If you receive this in error, please notify sender immediately, or us at www.foxsys.com and delete from your system. >>> Deborah Campbell <[EMAIL PROTECTED]> 09/03/02 12:55 PM >>> Forgive my ignorance, but I can never seem to get my hands completely around this Group Health Plan thing. Both insured and self-funded group health plans are covered entities if they use an insurer or TPA to administer their plan and they have 50 or more participants. It has been made clear to me that even if a GHP uses an insurer to administer their plan, they are still a CE and need to apply for the TCS extension. But here are my questions: 1) This means that almost every employer in the US will need to apply for the extension, or have their insurer apply on their behalf, correct? And this is whether they are self-funded or not. 2) Does this make the insurer a BA of the group? This would mean as an insurer, we would probably need to apply for an extension on behalf of almost every group we have and have BA Agreements with them all. This seems extreme, like I'm missing something. Any help is appreciated. 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. ********************************************************************* The WEDI SNIP listserv to which you are subscribed is not moderated. 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