If you are a resident of Montana and don't have an employer -
sponsored group health plan, you may want to acquire individual Montana health insurance from a private insurance carrier.
If you are employed, in all probability you are already insured under an employer
sponsored group health plan.
The option to purchase individual coverage offered to a person who will no longer be eligible for coverage through an employer -
sponsored group health plan.
Policyholders can contact their insurance carrier to request a Certificate of Creditable Coverage for use when transitioning from Short - Term to an employer -
sponsored group health plan.
If an employer -
sponsored group health plan is closely linked to an employer, the group health plan may be subject to ADA confidentiality restrictions, as well as this privacy regulation.
However, we have added several categories, such as IRBs and employer
sponsored group health plans, which are not small entities, per se, but will be effected by the final rule and we were able to identify costs imposed by the regulation on them.
The commenters stressed that while group health plans are clearly covered entities, the Department does not have the statutory authority to cover employers or other entities that
sponsor group health plans.
The high cost of healthcare makes employer
sponsored group health plans an attractive employee benefit.
Not exact matches
«The PBM industry is known for «business as usual» and has been challenged to bring real value to
plan sponsors (
health plans, ACO's, FFS government programs, self - funded
groups).
Our tailored, world - class services for all
plan sponsors —
health plans, accountable care organizations (ACOs), state Medicaid programs, employer
groups and unions — blend state - of - the - art technologies with experienced and talented professional teams to optimize your return on investment while enhancing your competitive stance in the market.
Our customized, world - class services for all
plan sponsors —
health plans, accountable care organizations (ACOs), state Medicaid programs, employer
groups and unions — blends state - of - the - art technologies with experienced and talented professional teams to optimize your return on investment while enhancing your competitive stance in the market.
Its tailored, world - class services that reduce overall pharmacy costs, reduce avoidable drug impacted medical costs, and optimize specialty drug spend while improving patient quality of life are for all
plan sponsors —
health plans, accountable care organizations (ACOs), exchanges, state Medicaid programs, and employer
groups.
Our best in class people, process and technology are aligned to support all
plan sponsors —
health plans, Accountable Care Organizations (ACOs), State Medicaid programs, employer
groups, and unions.
Our tailored, world - class services for all
plan sponsors —
health plans, accountable care organizations (ACOs), state Medicaid programs, employer
groups and unions — blend state - of - the - art technologies with experienced and talented professional teams to optimize
plan sponsors return on investment while enhancing organization's competitive stance in the market.
Our tailored, world - class services are for all
plan sponsors —
health plans, accountable care organizations (ACOs), exchanges, state Medicaid programs, and employer
groups.
Although employer -
sponsored self - insured and insured large
group health plans are not obligated to offer EHBs, they still can not place lifetime or annual limits on EHBs provided under the
plan.
The term «eligible employer -
sponsored plan» means, with respect to any employee, a
group health plan or
group health insurance coverage offered by an employer to the employee which is --
Performed HIPAA analysis for
plan sponsor's
group health plans, including drafting of policies and procedures and negotiation of business associate agreements.
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.
In the final regulation we allow
group health plans to disclose protected
health information to
plan sponsors if the
plan sponsor voluntarily agrees to use the information only in accordance with the purposes stated in the
plan documents and as permitted by the regulation.
This information does not constitute de-identified information because there may be a reasonable basis to believe the information is identifiable to the
plan sponsor, especially if the number of participants in the
group health plan is small.
It also permits a
plan sponsor to get summary information as part of its consideration of whether or not to change the benefits that are offered or employees or whether or not to terminate a
group health plan.
Also, some
plan sponsors that perform administrative functions on behalf of their
group health plans, may need protected
health information.
(B) Ensure that any agents, including a subcontractor, to whom it provides protected
health information received from the
group health plan agree to the same restrictions and conditions that apply to the
plan sponsor with respect to such information;
Plan sponsors have access to protected health information only to the extent group health plans have access to protected health information and plan sponsors are permitted to use or disclose protected health information only as would be permitted by group health pl
Plan sponsors have access to protected
health information only to the extent
group health plans have access to protected
health information and
plan sponsors are permitted to use or disclose protected health information only as would be permitted by group health pl
plan sponsors are permitted to use or disclose protected
health information only as would be permitted by
group health plans.
We do not require a business associate contract for a
group health plan to make disclosures to the
plan sponsor, to the extent that the
health plan meets the applicable requirements of § 164.504 (f).
Most operations of the
group health plan are contracted out to other entities or are carried out by employees of the employer who
sponsors the
plan.
Response: De-identified information is not sufficient for many functions
plan sponsors perform on behalf of their
group health plans.
Among the conditions for
group health plans to disclose information to
plan sponsors, the
plan sponsor must establish firewalls to prevent unauthorized uses and disclosures of 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.
To provide access to protected
health information by the
group health plan, a
plan sponsor will have to assess the current flow of protected
health information from their issuer and determine what information is necessary and appropriate.
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.
A
group health plan, however, may not permit an issuer or HMO to disclose protected
health information to a
plan sponsor unless the requirement in § 164.520 states that this disclosure may occur.
(4) A
group health plan and one or more other
group health plans each of which are maintained by the same
plan sponsor; or
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 notice.
For example, a
group health plan may satisfy its notice requirement by providing a single notice to each covered employee of the
plan sponsor.
See § 164.504 (f) with respect to disclosures to
plan sponsors from a
group health plan or
health insurance issuer or HMO with respect to a
group health plan.
Plan sponsors that perform enrollment functions are doing so on behalf of the participants and beneficiaries of the group health plan and not on behalf of the group health plan its
Plan sponsors that perform enrollment functions are doing so on behalf of the participants and beneficiaries of the
group health plan and not on behalf of the group health plan its
plan and not on behalf of the
group health plan its
plan itself.
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.
The
group health plan is not required to have a business associate contract with the
plan sponsor to disclose the protected
health information or allow the
plan sponsor to create protected
health information on its behalf, if the conditions of § 164.504 (e) are met.
However, employers and other
plan sponsors — particularly those
sponsors with self - insured
group health plans — may perform certain functions that are integrally related to or similar to the functions of
group health plans and, in carrying out these functions, often require access to individual
health information held by the
group health plan.
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.
The final rule permits
group health plans, and allows them to authorize
health insurance issuers or HMOs with respect to the
group health plan, to disclose protected
health information to
plan sponsors if the
plan sponsors voluntarily agree to use and disclose the information only as permitted or required by the regulation.
The preamble to the Transactions Rule noted that
plan sponsors of
group health plans are not covered entities and, therefore, are not required to use the standards established in that regulation to perform electronic transactions, including enrollment and disenrollment transactions.
Under the privacy rule, however, the
plan sponsor could not obtain any information from the
group health plan or a covered provider unless authorization was given.
Any employee of the
plan sponsor who receives protected
health information for payment,
health care operations or other matters related to the
group health plan must be identified in the
plan documents either by name or function.
See the preamble on § 164.504 for a discussion of specific «firewall» and other organizational requirements for
group health plans and their employer
sponsors.
Some
plan sponsors may need information, not to administer the
group health plan, but to amend, modify, or terminate the
plan.
We recognize that is some instances a
plan sponsor may provide benefits through more than one
group health plan, and that such
plans may fund the benefits through one or more issuers or HMOs.