Guiding Principles

Helping employees to get answers to their personal health benefits questions is a common responsibility for benefit administrators (BAS).

Many employees turn to their business advantage for help because they feel that BA is better able to get accurate and timely information from health insurance carrier. But there are rules and restrictions that govern how the BAS can get specific information about the health of the employees.

In the past, BAs insurance carrier just asks a question related to the personal health of an employee and the carrier could provide the answer directly to BA. However, this has changed. In today's workplace, there are rules and restrictions for obtaining health information on a specific employee. The federal and state authorities have issued strict guidelines with strict penalties for misuse or unauthorized disclosure of a person's protected health information (PHI).

It is therefore important that companies and their designated representative understands the benefits of these rules and regulations and how they relate to the sharing of an employee's PHI.

Getting permission

Benefit managers can still help employees answer their own health issues, but they must now follow the guidelines set by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The HIPAA regulations, effective April 14, 2003, establish specific policies and procedures for use and disclosure of an individual's protected health information.

In order to investigate the employee's behalf, BA obtain written consent from the employee. The authorization form is usually specific to the health benefits company in which the study takes place and includes a number of elements required under HIPAA, including limitations in the permit, effective and termination dates and details of individual rights under the permit .

Some health benefits companies will only accept an original consent form, while others will accept a faxed copy.

Receiving an answer

When an appropriate form is received by health benefits company, a response to BA's investigation may be released. The information will be reported back to the BA will be the "minimum necessary" - the smallest amount of information necessary to answer the question is limited to the range of permission.

For example, if the initial investigation was whether a claim has been processed for payment would be the health benefits carrier to answer "no" or answer "yes", which includes the date of payment. Based on the extent and Wording of the question, what was alleged, and the amount paid can not be disclosed.

If this additional information is needed, it must be treated in the initial question, and should be included in the range of authorization, the employee shall be granted. HIPAA guidelines are in place to protect an individual's personal health information. The federal and state authorities are aware of what can and can not be shared without authorization and may impose civil and monetary fines for noncompliance.

But these rules are not that BAS can not help employees get answers to their personal health issues. Understanding HIPAA guidelines and your health benefits company policy on consent forms will give your BA to continue to help employees find out answers to important health benefits issues.