| Helping employees get answers to their
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| | individual's rights under the
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| personal health benefits questions is a
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| | authorization.
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| common responsibility for benefit
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| | Some health benefits companies will only
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| administrators (BAs).
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| | accept an original consent form; others
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| Many employees turn to their company's
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| | will accept a faxed copy.
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| benefit administrator for assistance
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| | Receiving a response
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| because they feel the BA is in a better
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| | Once the appropriate form is received by
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| position to get accurate and timely
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| | the health benefits company, a response
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| information from the health insurance
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| | to the BA's inquiry can be released. The
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| carrier. However, there are rules and
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| | information that will be reported back to
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| restrictions that govern how BAs can
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| | the BA will be the "minimum necessary" -
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| obtain specific health information for
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| | the least amount of information necessary
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| employees.
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| | to answer the question, limited to the
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| In the past, BAs could simply ask the
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| | range of permission.
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| health insurance carrier a question
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| | For example, if the initial inquiry was
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| related to the personal health of an
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| | regarding whether a claim had been
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| employee and the carrier could provide
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| | processed for payment, the health
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| the answer directly to the BA. However,
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| | benefits carrier would provide a response
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| this has changed. In today's workplace,
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| | of "no" or a response of "yes" that would
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| there are rules and restrictions for
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| | include the date of payment. Based on the
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| obtaining health information on a
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| | scope and wording of the question, what
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| specific employee. The federal and state
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| | the claim was for and the amount paid may
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| governments have issued strict guidelines
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| | not be disclosed.
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| with severe penalties concerning the
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| | If this additional information is needed,
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| misuse or unauthorized disclosure of an
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| | it must be addressed in the initial
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| individual's protected health information
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| | question and would have to be included in
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| (PHI).
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| | the range of permission that the employee
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| Therefore, it is important that companies
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| | granted. HIPAA guidelines are in place to
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| and their designated benefits
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| | protect each individual's personal health
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| representative understand these rules and
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| | information. The federal and state
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| regulations and how they pertain to
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| | governments are clear as to what can and
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| sharing an employee's PHI.
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| | cannot be shared without authorization
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| Getting permission
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| | and may impose civil and monetary fines
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| Benefit administrators can still help
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| | and penalties for noncompliance.
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| employees obtain answers to their
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| | However, these regulations do not mean
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| personal health questions but they must
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| | that BAs cannot help employees receive
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| now follow the guidelines set forth by
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| | answers to their personal health
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| the Health Insurance Portability and
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| | questions. Understanding HIPAA guidelines
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| Accountability Act of 1996 (HIPAA). The
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| | and your health benefit company's
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| HIPAA regulations, effective April 14,
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| | policies regarding authorization forms
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| 2003, impose specific policies and
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| | will allow your BA to continue to help
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| procedures governing the use and
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| | employees find out answers to important
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| disclosure of an individual's protected
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| | health benefit questions.
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| health information.
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| | For more information on HIPAA guidelines,
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| In order to make an inquiry on an
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| | visit or review the HIPAA Regulations at
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| employee's behalf, the BA must obtain
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| | the Department of Health and Human
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| written consent from the employee. The
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| | Services Web site,
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| authorization form is usually specific to
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| | LINDA JONES has more than 16 years of
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| the health benefits company to which the
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| | experience in the health care industry.
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| inquiry is being made and must contain
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| | She has been with Vista Health Plan Inc.
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| certain elements required under HIPAA,
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| | since 1994. As manager of account
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| including the limitations of the
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| | services, she is responsible for
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| authorization, effective and termination
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| | membership growth and retention of small
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| dates, and information regarding the
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| | and large employer groups.
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