RE: GHP - TCS extensions

[Kevin Fairlie]

Title: GHP - TCS extensions

Deborah -

 

The act of an insurer filing an extension on behalf of the group health plan would not, in my opinion, make the insurer a BA of the GHP.  I say this because there is no exchange of PHI in filing for one of these extensions.  In order for a BA relationship to exist there has to be an exchange of PHI.  I don't consider any of the information that I've used while filling out these ASCA extension forms to be PHI. 

 

With that said, a BA relationship will probably exist between the insurer and the GHP otherwise, but not from the act of filing the extension.

 

Kevin Fairlie
Diekemper, Hammond, Shinners, Turcotte and Larrew, P.C.
7730 Carondelet, Suite 200
St. Louis, MO 63105
Phone: (314) 727-1015
Fax: (314) 727-6804

-----Original Message-----
From: Deborah Campbell [mailto:[EMAIL PROTECTED]]
Sent: Tuesday, September 03, 2002 12:39 PM
To: [EMAIL PROTECTED]
Subject: GHP - TCS extensions

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. 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/.
Posting of advertisements or other commercial use of this listserv is
specifically prohibited.

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/.
Posting of advertisements or other commercial use of this listserv is
specifically prohibited.