Plan Assets

[Guest shiker]

With the new HIPAA rules coming into play soon on protected health information, I have run across an interesting question:

Is the particpant health and claims information which is held by the insurance companies, claims admin, etc (i.e. "covered entities") a plan asset under ERISA? This information is very valuable and can be easily sold (and usually is).

[KIP KRAUS]

I’m not sure that one could consider claims and participant health status as an asset of a medical plan. Health insurers, I’m sure, use claims data and health statistics as general data to be used in underwriting and may sell this general statistical data to third party claims administrators, and other insurers, but I doubt that it identifies any particular person or employer as the source of the data. I may be naive in assuming this but it would appear to me that identifying individual health status or an employer would cause for legal action against the insurer.

Having said that, however, stop loss carriers use individual health data to lazar out plan participants that they will not cover, or will cover under specific restrictions. To me this could be a major problem HIPAA rules.