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Employee Benefit DallasProviding accurate information on HIPAA Compliance is one of the areas Diversified Benefit Services excels in.  We are industry leaders in providing low cost solutions to all of your regulatory responsibilities.  Both fully-insured and self-insured plans have responsibilities under HIPAA.

HIPAA's Impact on Employees

Under HIPAA, there are two components of an employer the group health plan and the plan sponsor. The group health plan is directly regulated by HIPAA regulations. Employers, as plan sponsors, will indirectly be subject to portions of HIPAA law.  HIPAA regulations may vary for your company depending on which component wishes to receive PHI.  The following scenarios apply to Self-Insured plans receiving Summary Health Information (SHI) and Protected Health Information (PHI).

The following guidelines are provided as an information service only.  This is not intended to serve as legal counsel. Use the information below as a quick reference only. To ensure your health plans are in compliance, call us (DBS). 

Group Health Plans (Employees who administer on behalf of employer)

  • Refrain from interfering with employees exercising their rights under the Privacy Rule (e.g., requesting access to or a copy of their health information, filing a privacy complaint).
  • Refrain from requiring any person to waive rights under the Privacy Rule as a condition of receiving payment, enrolling in a health plan or being eligible for benefits.
  • Designate a Privacy Official who is responsible for the development and implementation of the group health plans policies and procedures; and who is responsible for receiving complaints filed under the Privacy Rule.
  • Establish policies and procedures concerning PHI that comply with the Privacy Rule.
  • Train all members of the workforce on the group health plans PHI policies and procedures.
  • Establish appropriate administrative, technical, and physical safeguards to protect the privacy of PHI from intentional or unintentional use or disclosure.
  • Provide a process for individuals to make complaints concerning the group health plans policies and procedures, or its compliance with its policies and procedures.
  • Establish and apply appropriate disciplinary measures against members of its workforce for violations of the group health plans policies and procedures.
  • Provide Notice of Privacy Practices to members of the group health plan.
  • Send agreements to business associates to ensure HIPAA compliance dealing with PHI.

Plan Sponsors (Employers)

  • Prior to any release of PHI to a plan sponsor, the plan sponsor must provide certification to the group health plan that the plan documents have been amended to incorporate the following provisions:
  • Only disclose PHI as permitted by the plan documents or as required by law;
  • Not use or disclose the PHI for employment-related actions or decisions, or in connection with any other benefit or employee benefit plan of the sponsor;
  • Ensure "adequate separation" of records and employees is established and maintained between the group health plan and the plan sponsor;
  • Ensure agents and subcontractors (e.g., benefits consultants) agree to abide by the same restrictions and conditions as the plan sponsor in regard tot he use of PHI received from the group health plan;
  • Report any improper use or disclosure of PHI to the group health plan;
  • Allow individuals to inspect and obtain copies of PHI about themselves;
  • Allow individuals to request to amend PHI about themselves;
  • Provide individuals with an accounting of disclosures of PHI made within the six years prior to the request for such accounting;
  • Return or destroy PHI provided by the group health plan that is still maintained by the plan sponsor when no longer needed for purpose the disclosure was made.  If not feasible, then limit the use and disclosure to those purposes; and
  • Make its internal practices, books and records relating to the use and disclosure of PHI available to the Department of Health and Human Services (HHS) for purposes of auditing the group health plans compliance with the Privacy Rule.

Providing unparalleled Low Cost HIPAA Solutions and Value to our clientele is our main goal here. We look forward to working with you on all your needs and questions.  In short, we are here to help! Contact us today for more information on these and other topics as they relate to HIPAA.


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