From: Maul, Beth [mailto:[EMAIL PROTECTED]]
Sent: Tuesday, September 03, 2002 6:14 PM
To: [EMAIL PROTECTED]
Subject: Please remove me from this list
Please remove me from this list.
-----Original Message-----
From: Leah Hole-Curry [mailto:[EMAIL PROTECTED]]
Sent: Tuesday, September 03, 2002 1:50 PM
To: [EMAIL PROTECTED]
Subject: Re: GHP - TCS extensionsDeborah,
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 82476Third 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
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>>> 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 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
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