HIPAA Certificates of Coverage

[Guest g027331]

Our group health plan, EAP (Employee Assistance Plan), Medical Retiree Plans and Health FSA's are subject to HIPAA.

With respect to certificates of coverage, we are providing one for our group health plan. We are not, however, providing anything for our EAP and health FSA's and I'm not certain about our Retiree Medical plans. With the little that I know about this, it seems like we should be providing a certificate for our group health plan, EAP & Medical retiree plans. Any thoughts?

[papogi]

If you have a group health plan which is a comprehensive plan and not limited scope, your FSA's should not be subject to HIPAA. I'm curious why you think it is subject to HIPAA. Without knowing more details, you should probably be providing HIPAA certs for your group health plan and for your retiree group health plan. The EAP and FSA should be exempt.

[Guest g027331]

Thank you for your response. Our external legal counsel advised us that the plans that I listed are subject to HIPAA, while our dental, vision and dependant care FSA's are exempted.

Are you saying that EAP's and health FSA's are generally exempted from HIPAA? If it turns out that our EAP and health FSA"s are, indeed, subject to HIPAA, do we need to send out separate certificates of coverage for these plans?

[papogi]

I was not clear with respect to EAP's. EAP's are usually subject to HIPAA, however this never comes into play if you also offer comprehensive group health coverage. You would issue one certificate in this case, referencing the more complete coverage (the group health plan), in effect encompassing the group health coverage as well as the EAP. If a company's FSA's are subject to HIPAA, the certificate would only reference the FSA. If the company offers comprehensive group health coverage, the FSA's are exempt, even if an employee opts out of coverage but has an FSA. A cert would not even need to be provided to that individual. Unless you misunderstood your lawyers, they are wrong in regards to the FSA's.