HIPAA and self-insured plans

[Guest tkellogg]

We sponsor a mid-sized self-insured medical plan and medical spending account benefits. While we do not pay claims, we electronically transmit enrollment information. Based on what I have read, it does not appear that we are considered a group health plan for HIPAA compliance purposes. Has anyone else reached the same conclusion for a similar situation?

[jeanine]

Your health plan is a Covered Entity under HIPAA. All health plans are Covered Entities except self-funded health plans with less than 50 enrollees where the plan is self-administered. By virtue of the fact that a TPA processes your claims (I'm assuming this from your post), you are a Covered Entity.

[Steve72]

Jeanine is absolutely right. However, it is possible your plan is a "small health plan" that has a on year extended deadline for compliance with both the privacy and transaction standards rules.

For a self-insured plan, small health plans are generally those with less than $5,000,000 paid for health claims in the previous year.