Privacy Regs and large/small plan clarification

[Guest Nodak]

I am having trouble defining “plan” as it relates to the HIPAA privacy rules. If I have a health plan, dental plan and vision plan, do I have 3 plans each of which needs to meet the 5 million dollar threshold to be considered “large?” Or, are these plans viewed collectively as a “benefit plan” and I should total all of the gross receipts for all plans together to determine if we are over/under 5 million? In a nutshell, I don’t know if we are large or small, but I figure I still have 4 days to comply, so I’m not worried … I’m just having a nervous breakdown. Ahhhh!!!

[Christine Roberts]

The medical, dental, and vision arrangements are all "health plans" under HIPAA. I think you need to start with how your plans are documented and whether they report separately to the IRS with Form 5500.

If any of the component plans reports over $5 million in claims or premiums on a form 5500 you have a large plan.

I would argue if you have a wrap document and any one component exceeds the $5 million threshold, the whole arrangement is subject to the April 14, 2003 deadline.

But I would welcome differing opinions/comments.

[Steve72]

I think it's ambiguous whether multiple health plans "wrapped" together could constitute one or more plans for HIPAA purposes. Whichever stance the employer takes, all activities should be consistent with that stance (i.e., if the employer takes advantage of the small plan extension, the plans should be treated as separate entities come April 14, 2004).