Please remove me from this list.
Len Lacroix
Project Manager, HIPAA
Anthem East
Office phone: (603) 695-7829
Office Fax: (603) 645-5819
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"Paula Cullins"
<pcullins@cmh-sh. To: <[EMAIL PROTECTED]>
org> cc:
Subject: RE: Please remove me from
this list
09/05/02 05:28 PM
Please remove me from this list.
-----Original Message-----
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 extensions
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
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Systems, Inc. It is intended only for the person or
entity to which it
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receive this in
error, please notify sender immediately, or us at
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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]
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