Employer receives EOB's

[Guest TaxLady]

Is it legal for the employer to receive the EOB's for a fully insured health insurance plan. The employer in question opens all EOB records and then gives them to the employee. The EOB's are not mailed to the employees home addresses.

[Guest jreddi]

If I were advising the employer, I would tell him to immediately cease opening the envelopes. I would also tell him to contact the carrier and have the EOB mailed directly to the insured. I can't think of a reason why the employer would need to receive a copy of the EOB. I know, in my last position, our dental carrier sent a copy to me. I told them I didn't need a copy and they stopped sending me them.

It may be just a privacy issue and not a legal issue....until one of those not-so-well employees is denied a promotion or a raise and blames the employer for a violation of ADA. Then watch what hits the fan!

[Guest TaxLady]

I agree with you that it is inadvisable for the employer to receive the EOB's, but I was looking for information about the legality. Although the owner has heard the arguments you present, they are still receiving the EOB's. I am an employee of this company and I don't think it is right that they see my and others medical information. I am in a position to advise them, but they don't always listen to my advice. I was hoping to find something legal to persuade them, since the common sense approach didn't seem to work.

[Guest jreddi]

While I am not a lawyer (nor do I play one on TV), I have about 8 years managing benefits plans for attorneys. So....I did a little research.

First, there are Fourth Amendment considerations and the employee's right to privacy. Second, there are ADA considerations. Namely that ADA requires that any medical records collected must be kept in a separate file and can only be disclosed in three situations: 1.when supervisors or managers need to be informed regarding necessary restrictions on work or duties in direct regard to reasonable accommodation; 2. when first-aid or safety personnel need to be informed about a disability that might require emergence treatment; 3. when government officials investigating compliance need access to the records. (42 USC Sec 12112©(3)(B).

If you are sitused in California, the rules are even more stringent as CA has enacted CAL CIV CODE Section 56.20(a) which states that employee medical records must remain confidential and security systems must be in place so that they will be protected from unauthorized use.

By opening, reading and then distributing to the employee the employee's own medical records, the company is not exercising "due care" to insure that these records have a restricted access. So, armed with the Fourth Amendment, the ADA, California Civil Code, the Minnesota Civil Code and even HIPAA, you should be able to show that the employer has NO RIGHT or REASON to continue this practice.

I would hate to be defense counsel should they go to trial.