Sentences with phrase «sponsored group health plans»

The high cost of healthcare makes employer sponsored group health plans an attractive employee benefit.

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.

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.

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.

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.

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.

If you are employed, in all probability you are already insured under an employer sponsored group health plan.

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.

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 plPlan 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 plplan 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 itsPlan 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 itsplan and not on behalf of the group health plan itsplan 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.