Sentences with phrase «health insurance issuers in»

We recognize the potential for confusion, as coverage offered through an Exchange is offered by «a health insurance issuer in the individual market,» but this coverage is subject to the special enrollment rule at § 155.420 (d), which is intended to require special enrollment periods for triggers including those listed in the exceptions in paragraph (b)(2)(i).

Not exact matches

In developing the GOT regulation, the Departments accounted for wide variation in how group health plans and health insurance issuers determine both in - network and out - of - network rates, and made a determination to base the GOT criteria on existing provisions of federal laIn developing the GOT regulation, the Departments accounted for wide variation in how group health plans and health insurance issuers determine both in - network and out - of - network rates, and made a determination to base the GOT criteria on existing provisions of federal lain how group health plans and health insurance issuers determine both in - network and out - of - network rates, and made a determination to base the GOT criteria on existing provisions of federal lain - network and out - of - network rates, and made a determination to base the GOT criteria on existing provisions of federal law.

Thus, the Departments concluded in the November 2015 final rule, and still maintain, that the existing GOT regulation provides a statutorily supportable, and also a more practical, and cost - effective approach for group health plans and health insurance issuers to determine the required minimum payment amounts.

«These interim final regulations are necessary in order to provide rules that plan sponsors and issuers can use to determine which changes they can make to the terms of the plan or health insurance coverage while retaining their grandfather status»

Business Development: Brokering various business dealings that further the diversification of Indian economies Developing and accessing commercial financial programs and services for tribal governments, including tax - exempt offerings and federally - guaranteed housing loans Serving as issuer or underwriter's counsel in tribal bond issuances Ensuring tribal compliance with Bank Secrecy Act and other federal financial regulatory requirements Handling federal and state income, excise, B&O, property and other tax matters for tribes and tribal businesses Chartering tribal business enterprises under tribal, state and federal law Registering and protecting tribal trademarks and copyrights Negotiating franchise agreements for restaurants and retail stores on Indian reservations Custom - tailoring construction contracts for tribes and general contractors Helping secure federal SBA 8 (a) and other contracting preferences for Indian - owned businesses Facilitating contractual relations between tribes and tribal casinos, and gaming vendors Building tribal workers» compensation and self - insurance programs Government Relations: Handling state and federal regulatory matters in the areas of tribal gaming, environmental and cultural resources, workers» compensation, taxation, health care and education Negotiating tribal - state gaming compacts and fuel and cigarette compacts, and inter-local land use and law enforcement agreements Advocacy before the Washington State Gambling Commission, Washington Indian Gaming Association and National Indian Gaming Commission Preparing tribal codes and regulations, including tribal court, commercial, gaming, taxation, energy development, environmental and cultural resources protection, labor & employment, and workers» compensation laws Developing employee handbooks, manuals and personnel policies Advocacy in areas of treaty rights, gaming, jurisdiction, taxation, environmental and cultural resource protection Brokering fee - to - trust and related real estate and jurisdictional transactions Litigation & Appellate Services: Handling complex Indian law litigation, including commercial, labor & employment, tax, land use, treaty rights, natural and cultural resource matters Litigating tribal trust mismanagement claims against the United States, and evaluating tribal and individual property claims under the Indian Claims Limitation Act Defending tribes and tribal insureds from tort claims brought against them in tribal, state and federal courts, including defense tenders pursuant to the Federal Tort Claims Act Assisting tribal insureds in insurance coverage negotiations, and litigation Representing individual tribal members in tribal and state civil and criminal proceedings, including BIA prosecutions and Indian probate proceedings Assisting tribal governments with tribal, state and federal court appeals, including the preparation of amicus curiae briefs Our Indian law & gaming attorneys collaborate to publish the quarterly «Indian Legal Advisor ``, designed to provide Indian Country valuable information about legal and political developments affecting tribal rights.

A group health plan must require a health insurance issuer or HMO providing coverage to the group health plan to disclose information to the plan sponsor only as provided in the plan documents.

Individuals enrolled in a group health plan that provides benefits only through an insurance contract with a health insurance issuer or HMO would have access to all rights provided by this regulation through the health insurance issuer or HMO, because they are covered entities in their own right.

If a group health plan provides health benefits solely through an insurance contract with a health insurance issuer or HMO, and the group health plan creates or receives protected health information in addition to summary information (as defined in § 164.504 (a)-RRB- and information about individuals» enrollment in or disenrollment from a health insurance issuer or HMO offered by the group health plan, the group health plan must maintain a notice that meets the requirements of this section and must provide the notice upon request of any person.

We proposed that this definition include, but not be limited to the 15 types of plans (e.g., group health plan, health insurance issuer, health maintenance organization) listed in the statute, as well as any combination of them.

Additionally, a prospective health insurance issuer may need claims information from a plan sponsor in order to provide rating information.

We also note that under § 164.504 (f), a group health plan and a health insurance issuer that provides benefits with respect to a group health plan are permitted in certain circumstances to disclose summary health information to the plan sponsor for the purpose of obtaining premium bids.

We have included this certification requirement in part, as a way to reduce the burden on health insurance issuers and HMOs.

We note that when a plan sponsor has several different group health plans, or when such plans provide insurance or coverage through more than one health insurance issuer or HMO, the covered entities may jointly engage in this type of analysis as a health care operation of the organized health care arrangement.

In addition, group health plans that provide health benefits only through an insurance contract and do not create, maintain, or receive protected health information (except for summary information described below or information that merely states whether an individual is enrolled in or has been disenrolled from the plan) do not have to meet the notice requirements of § 164.520 or the administrative requirements of § 164.530, except for the documentation requirement in § 164.530 (j), because these requirements are satisfied by the issuer or HMO that is providing benefits under the group health plaIn addition, group health plans that provide health benefits only through an insurance contract and do not create, maintain, or receive protected health information (except for summary information described below or information that merely states whether an individual is enrolled in or has been disenrolled from the plan) do not have to meet the notice requirements of § 164.520 or the administrative requirements of § 164.530, except for the documentation requirement in § 164.530 (j), because these requirements are satisfied by the issuer or HMO that is providing benefits under the group health plain or has been disenrolled from the plan) do not have to meet the notice requirements of § 164.520 or the administrative requirements of § 164.530, except for the documentation requirement in § 164.530 (j), because these requirements are satisfied by the issuer or HMO that is providing benefits under the group health plain § 164.530 (j), because these requirements are satisfied by the issuer or HMO that is providing benefits under the group health plan.

(9) In the definition of «health insurance issuer,» addition of the relevant statutory cite, deletion of the term «or other law» after «state law,» addition of health maintenance organizations for consistency with the statute, and clarification that the term does not include a group health plan; and

If the employer sponsors more than one group health plan, or if its group health plan provides coverage through more than one health insurance issuer or HMO, the different covered entities may be an organized health care arrangement and be able to jointly participate in such an analysis as part of the health care operations of such organized health care arrangement.

In addition, if a group health plan, or a health insurance issuer or HMO with respect to a group health plan, wants the option to disclose protected health information to a group health plan sponsor without authorization as permitted under § 164.504 (f), the group health plan, health insurance issuer or HMO must describe that practice in its noticIn addition, if a group health plan, or a health insurance issuer or HMO with respect to a group health plan, wants the option to disclose protected health information to a group health plan sponsor without authorization as permitted under § 164.504 (f), the group health plan, health insurance issuer or HMO must describe that practice in its noticin its notice.

We note that we sometimes refer in the rule and preamble to health insurance issuers and HMOs that provide health insurance or health coverage to a group health plan as health insurance issuers or HMOs with respect to a group health plan.

A group health plan, however, may not permit a health insurance issuer or HMO to disclose protected health information to a plan sponsor unless the notice required in 164.520 indicate such disclosure may occur.

A group health plan or health insurance issuer or HMO, or their business associate on their behalf, may perform such analyses for an employer customer and provide the results in de-identified form to the customer, using integrated data received from other insurers, as long as protected health information is not disclosed in violation of this rule.

Specifically, in order for a plan sponsor to obtain without authorization protected health information from a group health plan, health insurance issuer, or HMO, the documents under which the group health plan was established and is maintained must be amended to: (1) Describe the permitted uses and disclosures of protected health information by the plan sponsor (see above for further explanation); (2) specify that disclosure is permitted only upon receipt of a written certification that the plan documents have been amended; and (3) provide adequate firewalls.

(iii) Not disclose and may not permit a health insurance issuer or HMO to disclose protected health information to a plan sponsor as otherwise permitted by this paragraph unless a statement required by § 164.520 (b)(1)(iii)(C) is included in the appropriate notice; and (iv) Not disclose protected health information to the plan sponsor for the purpose of employment - related actions or decisions or in connection with any other benefit or employee benefit plan of the plan sponsor.

The definitions that were promulgated in the Transactions Rule and that remain unchanged here are: Act, ANSI, covered entity, compliance date, group health plan, HCFA, HHS, health care provider, health information, health insurance issuer, health maintenance organization, modify or modification, Secretary, small health plan, standard setting organization, and trading partner agreement.

(ii) A group health plan that provides health benefits solely through an insurance contract with a health insurance issuer or HMO, and that creates or receives protected health information in addition to summary health information as defined in § 164.504 (a) or information on whether the individual is participating in the group health plan, or is enrolled in or has disenrolled from a health insurance issuer or HMO offered by the plan, must:

(iii) A group health plan that provides health benefits solely through an insurance contract with a health insurance issuer or HMO, and does not create or receive protected health information other than summary health information as defined in § 164.504 (a) or information on whether an individual is participating in the group health plan, or is enrolled in or has disenrolled from a health insurance issuer or HMO offered by the plan, is not required to maintain or provide a notice under this section.

Without a certification, health insurance issuers and HMOs would need to review the plan documents in order to ensure that the amendments have been made before they could disclose protected health information to plan sponsors.

Individuals enrolled in such group health plans have the right to notice of the health insurance issuer or HMO's privacy practices and, on request, to notice of the group health plan's privacy practices.

(B) Information on whether the individual is participating in the group health plan, or is enrolled in or has disenrolled from a health insurance issuer or HMO offered by the plan.

(2) A health insurance issuer, defined as an insurance company, insurance service, or insurance organization that is licensed to engage in the business of insurance in a state and is subject to state or other law that regulates insurance.

In this case, the individuals enrolled in the group health plan would receive notice of the health insurance issuer or HMO's privacy practices, but would not be entitled to notice of the group health plan's privacy practiceIn this case, the individuals enrolled in the group health plan would receive notice of the health insurance issuer or HMO's privacy practices, but would not be entitled to notice of the group health plan's privacy practicein the group health plan would receive notice of the health insurance issuer or HMO's privacy practices, but would not be entitled to notice of the group health plan's privacy practices.

In 1996, HIPAA amended ERISA to require portability, nondiscrimination, and renewability of health benefits provided by group health plans and group health insurance issuers.

(3) A group health plan and a health insurance issuer or HMO with respect to such group health plan, but only with respect to protected health information created or received by such health insurance issuer or HMO that relates to individuals who are or who have been participants or beneficiaries in such group health plan;

A group health plan, and a health insurance issuer offering health insurance coverage in connection with a group health plan, that makes coverage available with respect to dependents is required to permit individuals described in paragraph (b)(2) of this section to be enrolled for coverage in a benefit package under the terms of the plan.

The definition of a «contributing entity» at § 153.20 provides that for the 2015 and 2016 benefit years, a contributing entity is (i) a health insurance issuer or (ii) a self - insured group health plan, including a group health plan that is partially self - insured and partially insured, where the health insurance coverage does not constitute major medical coverage, that uses a third party administrator (TPA) in connection with claims processing or adjudication, including the management of internal appeals, or plan enrollment for services other than for pharmacy benefits or excepted benefits within the meaning of section 2791 (c) of the PHS Act.

Section 147.104 (b)(2) incorporates certain triggering events for special enrollment periods described in the Exchange regulations at § 155.420 (d), and applies them to health insurance issuers offering non-grandfathered coverage in the individual market through or outside the Exchange.

(2) Offers to each covered individual, on a guaranteed issue basis, the option to purchase any other individual health insurance coverage currently being offered by the issuer for individuals in that market.