HIPAA

Definition of HIPAA
Disclosure of Health Information
Certificates of Coverage
Definition of HIPAA

HIPAA is the acronym for the Health Insurance Portability and Accountability Act of 1996 (as amended). HIPAA provides employees and dependents certain rights and protections related to their ability to transfer group health insurance from one employer to another. HIPAA includes protections against limitations or exclusions for preexisting conditions and prohibits discrimination against employees and dependents based on their health status. HIPAA also includes provisions related to the security and privacy of protected health information and the way it is used, shared, and stored by medical providers and insurance plans. The Health Information Technology for Economic and Clinical Health Act (HITECH Act) imposes additional administrative, physical, and technical safeguards for protected health information under HIPAA.  (For more information, visit www.hhs.gov/ocr/hipaa/)

As an Insurance Coordinator, it is your responsibility to maintain the security and privacy of employees’ and their dependents’ medical and personal information. Disclosure of this information to others is based on a need-to-know basis such as when completing insurance forms, granting medical leave, or discussing the Family Medical Leave Act (FMLA).  (See OSEEGIB Rules: 360:1-3-8)

Disclosure of Health Information 

All of the health plans available through OMES EGID and the HealthChoice Life Insurance Plan have processes in place that allow an employee and/or adult dependent to authorize the release of their personal health information. For specific information for each plan, the employee should contact their plan directly.

For the HealthChoice health plans and the HealthChoice Life Insurance Plan, a HIPAA Authorization to Disclose HealthChoice Information form must be on file for each person authorized to access the member’s/dependent’s information. An authorization remains in effect for one year unless an expiration date is indicated. To revoke an authorization, the member/dependent must complete and submit a HIPAA Revocation of Authorization to Disclose HealthChoice Information form. An authorization can be revoked at any time.

Members can use the authorization to allow a family member, friend, or provider access to personal health information. Members can also limit the information to a specific claim, medical condition, or time frame. Limitations must be indicated on line seven of the authorization form. Members should keep a copy of the original HIPAA Authorization to Disclose HealthChoice Information form.

If you have an employee that asks for your help dealing with a specific medical claim, know that HIPAA regulations require OMES EGID to protect the privacy of our members’ health information. OMES EGID is only permitted to disclose members’ medical information according to the terms of the OMES EGID Privacy Notice. You can assist an employee with eligibility or other enrollment issues; however, to discuss a specific claim issue with a customer service representative, the employee must submit a completed HIPAA Authorization to Disclose HealthChoice Information form granting you authorization. Please instruct the employee to limit the scope of the authorization to the specific claim or issue. If the claim is with an HMO plan, the employee must contact the HMO for the proper documentation to allow disclosure of personal health information.

Certificates of Coverage 

OMES EGID automatically provides a Certificate of Group Health Plan Coverage, also referred to as a Certificate of Coverage, HIPAA Certificate, or HIPAA Letter, to employees and covered dependents when medical benefits terminate.

If necessary, OMES EGID Member Services can provide a copy of a previously issued certificate or issue a certificate prior to the date coverage ends; however, the termination date must be in our system. Certificates issued by request  reflect the coverage information in the eligibility system at the time the request is made. You can assist OMES EGID in providing accurate eligibility dates by terminating coverage for employees and dependents in a timely manner.

Requests for certificates from anyone other than covered employees, covered dependents, or ICs are not accepted.

You can direct questions regarding Certificates of Group Health Plan Coverage to Member Services at 1-405-717-8780 or toll-free at 1-800-752-9475. TDD users call 1-405-949-2281 or toll-free 1-866-447-0436.

Proof of Other Group Coverage

An employee may need to provide proof of other group coverage when they move from one group insurance plan to another, or as documentation of a qualifying event.

Proof of other group coverage can include a:

• Certificate of Group Health Plan Coverage
• Military health benefits ID card
• Indian Health Services benefits ID card
• Letter from the previous employer indicating the effective date of coverage, the termination date of coverage, and the names of all covered dependents

Social Security numbers or member identification numbers of the employee and/or dependents are required with the proof of other coverage.

Proof of other group insurance coverage is also needed when waiving coverage through OMES EGID.