Group Health Insurance | Business Group Benefits

HIPAA. Perhaps one of the most significant laws in recent memory; certainly one of the most complex. While this short article won't make anyone an expert, it will, hopefully, demystify this wide ranging set of laws and put you on the path towards compliance.

First, let's answer the question "What is HIPAA?"
HIPAA stands for the Health Insurance Portability and Protection Act of 1996. Although it purports to regulate health insurance, HIPAA provisions extend far beyond insurance. HIPAA introduced broad disclosure and privacy requirements. It also established civil and criminal penalties for each violation (up to $25,000 per person per year in civil penalties and up to $250,000 in criminal fines - along with imprisonment).

Title I of HIPAA deals with portability and special enrollment rights for health plans. Those conditions must have been incorporated into your plans by now (original compliance date was 1997).

Title II of HIPAA governs a wide ranging set of conditions called, "Administrative Simplification". For those charged with compliance, the notion that HIPAA simplifies anything qualifies as "dark humor". Administrative simplification attempts to create a uniform system for processing and retention of health information and ensuring the security of that information.

For the purposes of this article, we're only concerned with those portions of the law impacting most employers...privacy. Notably the privacy of personal data defined by HIPAA as "Protected Health Information" or "PHI" - information that is personally identifiable. In the broadest summary possible, key components of HIPAA privacy requirements for a plan sponsor are fairly straightforward:

Generally, the employer (Plan Sponsor) is not a HIPAA "Covered Entity" - the Health Plan is. For fully insured plans, this typically means the health insurer, HMO, EAP provider, etc. As the Covered Entities, health plans bear the brunt of compliance requirements (your responsibilities become exponentially larger as the quantity of data you receive increases.)
Meet with every service provider, or ensure that your broker or consultant has reviewed compliance requirements with each. Use protected health information only for needed administration of the benefit programs (HIPAAspeak: "Treatment, Payment and Health Care Operations"); Collect (and release) only the minimum data required to "do the job" (e.g. enroll an employee, file claims, etc.) Restrict the data to those persons who absolutely must use it.
Establish "firewalls" and safeguards to protect the data (separate locked files, restricted access, password protect systems.)
Appoint a Privacy Official (not required for fully insured plans that never receive PHI.) Create a Privacy Policy and distribute a Privacy Notice to participants. "Scrub" personally identifiable data from communications pieces, ID Cards, etc.

HIPAA, like COBRA before it, will continually change as new rules and regulations are released (for example, the U.S. Dept. of HHS has yet to release enforcement rules for HIPAA). Ongoing compliance will require vigilance in remaining up to date on the changing laws. It's vital your broker/consultant proactively work with your organization to review plans, identify problems and provide ongoing education to maximize the performance of your benefit plans.

For one who takes pride in being involved with different community organizations, possessing a high level of confidence is essential. Especially when that involvement includes speaking to large and small groups requesting donations for numerous non-profit organizations.

Such is the case with Teresa Bock, Assistant Vice President of Wells Fargo Bank’s Olympus Hills Office in Salt Lake City. Not only is confidence a key to her success with all the community work she does, it is vital in her professional position.

When one first meets Teresa, they encounter a woman who is constantly smiling. This wasn’t always the case. Before marrying media personality Tom Bock, Teresa overcame numerous obstacles in her life.

At age seven, Teresa became completely deaf in her right ear due to Scarlet Fever. During that same period she lost most of the hearing in her left ear. Teresa has so beautifully conquered the command of her ability to communicate, most people would have no idea she is a master lip reader unless she tells them.

Another obstacle Teresa overcame was her struggle to make ends meet with two small children from a previous marriage. With food and shelter as a priority there were many things that were put on the back burner until they became absolutely necessary. Things like visits to a dentist. During those trying times dental visits were strictly for emergency and maintenance purposes. Although Teresa secretly desired a smile that would turn heads, with the incredible financial pressures that come with being a single mom, she wondered if obtaining a beautiful smile would ever be within reach.

With a strong drive to succeed, Teresa began her career in banking in 1987 as a teller. Taking on her career challenges with the same zest that she took on her physical challenges, Teresa found opportunities to move up in the banking industry as well as continue her involvement with non-profit organizations. During her employment, she learned that Wells Fargo has an ongoing commitment to giving back to the community. Seeing an opportunity to develop a career and contribute to her community, Teresa knew she had found a great match for her life’s passions.

It was during this time she met Tom Bock. What started out as two single parents enjoying each other’s company blossomed into love and marriage. In 2000, they married, bringing together a combined family of five children eight grandchildren. A strong tie for their marriage is love and respect for their individual interests and the fact both Tom and Teresa are actively involved in giving back to the community.

Not being one to settle for giving her energy to one organization, Teresa has been involved with Ballet West, Ririe-Woodbury Dance Company, Living Planet Aquarium, Audiologist Association, NAWBO (National Association of Women Business Owners) and various Chamber of Commerce organizations. She is absolutely convinced that being able to communicate both in one-on-one and public situations is critical to achieving the greatest outcome when it relates to raising money for an organization.

Not one to let go of her dreams, Teresa was also convinced that an improved smile would directly impact her confidence level. Although she had the desire to have her smile cosmetically improved, the cost was still a huge consideration.

What first sparked Teresa’s interest in a smile makeover were pictures of people who didn’t have obvious black lines near their gum lines. She also had a distinct taste of aluminum in her mouth. Having been to countless dentists over the years not one of them ever took time to explain what this was about. That is until she was introduced to Dr. Scott Kiser.

Teresa was referred to Dr. Kiser by a friend. She was so confident in his recommendations she didn’t bother with a second opinion even though he recommended she do so. She knew he was fair and would do the right thing.

When Teresa decided to invest in her smile makeover, Dr. Kiser showed her how to make it possible. He helped her to figure out the best way to move forward and help her fulfill her dream. Not only did Dr. Kiser address all of Teresa’s questions and concerns about her dental care, he showed her that with a good plan, her dream of a beautiful smile was well within reach.

As with many accomplishments in Teresa’s life, she had to develop a plan of action to determine how to afford what she wanted. One of the first things she did was to prioritize. First, she determined where she could cut spending. Secondly, she participated in the Wells Fargo Healthcare Spending Account. The program allows for having a portion of one’s paycheck put aside for various healthcare costs. Depending on the program, the monies can be used for vision, medical and/or dental fees. These programs allow you to set aside a specific pretax dollar amount to be used for unreimbursed healthcare expenses. Many employers now offer healthcare spending programs in their employee benefit packages.

“If someone thinks they can’t afford it they need to ask themselves if they really can afford not to do it. It can change someone’s life in ways they never dreamed possible,” beams Teresa. “There are always ways to figure out how to afford something if it becomes a great enough priority.”

Teresa will be the first to tell you that once she made the decision to move forward, things seemed to magically fall into place. She will also tell anyone who wants to know that her Smile Makeover is one of the best investments she ever made.

As she suspected, once she had an improved smile, her confidence rose incredibly. She found she was more willing to smile when talking to people and any insecurity she had about what people thought of her smile completely disappeared. She also found her confidence when speaking to groups greatly increased.

Teresa has been so pleased with her results she always refers people to Dr. Kiser. Many of Teresa and Tom Bock’s friends are patients of Dr. Kiser.

Although she didn’t always realize the importance of a great dental care provider, today she will be the first to admit you have to find someone you can trust. Someone who really cares about their patients and won’t rush through an appointment.

“When I visit Dr. Kiser I feel like I am the only person that matters. And when it comes to my dental care, that’s the way it should be. I didn’t always believe that but today I know I deserve that kind of treatment.”

Teresa also appreciates the commitment and care of the Smiles Dentistry staff. Teresa knows their staff is the best around. With state of the art equipment and décor that is extremely pleasing, she knows the investment Dr. Kiser has made to create an atmosphere that will be appreciated by even the most discriminating tastes.

“They really care about each patient. The first encounter one has is with Vicki. Whether they meet Vicki over the phone or in the front office, it is an incredibly positive experience. Complimented by Vicki’s “can do” attitude is an overall atmosphere that is beyond compare.”

“There are people in my life who never knew me before I had my smile makeover. Shock is often the response I get when they look at before and after pictures. Just to see their reaction makes me realize how great an investment Dr. Kiser’s work has been. Without a doubt, it is one of the best investments I have ever made. I will reap the benefits for years to come. It is such a great feeling when someone will comment on what a beautiful smile I have. I cannot begin to tell you what it has done to improve the quality of my life.”

“To Dr. Kiser and his entire team, I thank you from the bottom of my heart.”

But the situation changes when we consider the more extensive and more costly types of health care. The ability of a patient to obtain top quality medical care for the most serious types of health care - things like transplants, extended hospital care, physical rehabilitation, and long term outpatient care - depend more on whether the patient has adequate health insurance than any other factor.

A simple attack of appendicitis could easily wind up costing more than $25,000. Even an affluent family will have difficulty arranging adequate medical care without insurance coverage. Unfortunately, if you wait until you need this type of care it will be difficult or impossible to buy health insurance that covers these items.

Often the most immediate insurance concern for young people is the fact that most colleges, trade schools, internship programs, sports teams, community-sponsored travel opportunities and many other activities require health insurance as an admission requirement. Without health insurance, you do not pass "go". So there is usually no question about it - most young people with ambitions to advance their education need to have some type of health insurance.

Coverage Options
There are many types of health insurance plans available to young adults. The most popular plans are listed below. Parent's Policy - Most students continue to be covered under a parent's policy. If this option is available, it is almost always the best option. But most health plans require that proof of full-time enrollment be provided.
Be aware of the maximum age for this benefit. In many cases this coverage will expire when the student reaches age 23 (or at another age as stated in the insurance policy).
Employer Group Coverage - Most employers provide health insurance to their full time employees and pay for most of the cost of this employee benefit. This is called group health coverage. This benefit is completely under the control of the employer. Many people do not realize that there is no requirement for an employer to provide this benefit. Most group health plans require that new employees wait a few months before becoming eligible for coverage.
School-Sponsored Coverage – These are usually uninsured managed care arrangements to provide care to students in the local area of the college or university.
Student Medical Policies – These are privately insured major medical policies designed specifically for students. These are portable and offer coverage to the student in any location in the U.S. These plans also cover graduate students, and are available regardless of age or health.
In most parts of the U.S., students can buy a high quality health insurance plan for less than $70 per month at www.medsave.com.
Short Term Medical Policies - Interim or gap insurance policies are available to cover from one to 12 months. This coverage is inexpensive and easy to obtain online in most states. The quality of the coverage is excellent except that it does not cover pre-existing conditions. These provide coverage in the U.S. only.
Individual Medical Policies - Permanent policies that you buy directly from an insurance company offer excellent coverage, strongest financial guarantees, and the most stability. These often provide worldwide coverage. But all this comes at a higher price and coverage is issued for a minimum of 12 months.
Travel Coverage / International Policies - Students planning overseas travel should purchase a separate medical insurance plan for the time that they are traveling, since most student health plans do not cover charges incurred outside of the U.S. These policies are specifically designed to pay for medical expenses and deal with the other international complications (language, currency and business issues) typically incurred while obtaining medical treatment overseas.

Terms to Know
Deductible or Co-payment - this is the portion of the bill that you pay before the insurance comes into play. These help reduce the cost of the insurance.
HMO - stands for "health maintenance organization". The HMO may pay to keep you healthy, rather than only cover problems hen things go wrong. HMOs tend to be popular among young healthy people, but criticized by people receiving more serious medical care. Private physicians tend to feel that they lose control over the quality of a pateint's care when an HMO is involved.
Indemnity plan - means that the policy reimburses you for any ordinary and necessary medical expenses. This is the least restrictive type of coverage but also the most expensive.
Managed Care - this means that the insurer has some authority to influence the type of health care you are provided. This cuts healthcare costs but may also limit your treatment.
Pre-existing condition - a medical situation that started before your insurance policy that may not be covered by the health insurance policy.
Premium - the cost of the policy, usually ranging from $25 to over $200 monthly.
Tax-deductible - reduces your taxable income and thereby reduces your total tax due at the end of the year. Most health insurance is not tax deductible by individuals.
Tax-free - the benefit provided by health insurance is usually tax-free. This means the value of the coverage received as well as any cash benefit paid as the result of a claim.
Underwritten - this means that not everyone will be accepted because acceptance is based on individual medical history. The insurance company reviews each application and selects the healthiest applicants for enrollment. Premium rates are lower for those accepted, but these plans offer no solution for people with pre-existing health conditions.