HIPPA Plan Sponsor vs. Plan Administrator

kpiccoli

I'm currently working on HIPPA policies and I'm confused on whether or not we are just the Plan sponsor of our health and dental plans or are we also the Plan administrator/fiduciary? We have fully insured plans and just handle summary health information. Is the health insurance company the Plan Administrator? Do we have fiduciary responsibilities because we also handle COBRA, payroll deductions, eligibility, etc.? This is a real grey area!

LarryC

First of all, Plan Sponsor = Employer. Your insurance company will ADMINISTER the Group Health Plan (GHP) which HIPAA considers a separate legal entity. Since you are fully insured, you (employer) are not subject to the HIPAA privacy provisions as pertaining to your GHP's as long as you are only receiving summary information .

However, you still have fiduciary responsibilities regardless of HIPAA. Now you have ERISA looking over your shoulder. You have to make sure that you properly administer your health plans, COBRA, disability insurances, life insurance, unemployment, vacation benefits, 401(k), and anything else that ERISA considers to be an Employee Welfare Benefit Plan. I believe apprenticeship programs also qualify. Your business insurance should also cover you under the fiduciary liability coverage. For instance, you forget to enroll somebody in the health insurance, or you forget to send out a COBRA notice, etc., your insurance will cover you if an employee comes back at you for it.

I hope I helped. Let me know if I need to clarify something.