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