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