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ANSWER: A health plan with fewer than 50 participants that is administered by the sponsoring employer is excluded from the definition of a ?group health plan? under HIPAA's administrative simplification provisions, which include the privacy and security requirements.
Exceptions to the HIPAA Privacy Rule Limitations apply to uses and disclosures for the purpose of facilitating another party's activities. Exceptions are allowed for a covered entity to disclose PHI to: Any other provider (even a non-covered entity) to facilitate that provider's treatment activities.
What is a Non-Covered Entity Under HIPAA? As mentioned above, a non-covered entity is an entity that is not subject to the requirements of the HIPAA Privacy Rule. There are two types of non-covered entities under HIPAA: business associates and hybrid entities.
Hear this out loud PauseFor HIPAA purposes, health plans include: Health insurance companies. HMOs, or health maintenance organizations. Employer-sponsored health plans.
Hear this out loud PauseWhen you apply for a HIPAA plan, you should provide a Certificate of Creditable Coverage from your last health plan. This is a letter that says how long you have been covered and provides proof that you have had at least 18 months of coverage.
Hear this out loud PauseHealth plans: Medicare, Medicaid, Medicare+Choice, and Medicare supplement insurers. Long-term care insurers (excluding nursing home fixed-indemnity policies) Employer-sponsored group health plans. Government- and church-sponsored health plans.
As a recap, all plans that self-insure, have fewer than 50 participants and are internally administered, are exempt from the privacy rule.
Hear this out loud PauseThe definition of ?group health plan? is adopted from the statutory definition at section 1171(5)(A), and excludes from the rule as ?health plans? only the few insured or self-insured ERISA plans that have less than 50 participants and are self administered.