Information regarding claims provided to employer

[Guest KarinB]

I have an employer who is requesting the number of claims and dollar amount totals broken down in categories for unreimbursed medical. (Ie. dr visits, rx copays, vision, dental) Does anyone know if there is anything in the regulations that allows this. I thought that as long as it is an eligible expense it can be processed and the employer does not have the right to know what the employee is using the account for.

[GBurns]

More information in your post would have been helpful, such as whether the info is being requested from the insurance company (if fully insured) or the Claims administrator (if self funded) or whether this is FSA only info from the FSA Administrator. What is the employers relationship to the Plan? What type of Plan?

from your post all it seems that is being requested is summary info not individual details and no ICD etc.

If the info is be for a valid purpose such as utilization review and does not have any personally identifiable information (such as which claim or item belongs to whom, or what any individual did etc) there is nothing wrong with the Plan Sponsor getting this information.

The employer, if not also the Plan Sponsor should have no need for the information and therefore should have no right. But, the Plan Sponsor does.

[Kirk Maldonado]

KarinB:

I've never seen any authority that says that the employer can't have access to that information. On the other hand, I've never seen anything that says that the employer can have right to it.

Thus, it would depend on what the administrative services agreement provides.

However, if any of that information would indicate which claims are attributable to specific individuals, you need to get legal counsel to advise both the plan and the employer on the HIPAA implications of compiling and transmiting that information.