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ANSWER: A health plan with fewer than 50 participants that is administered by the sponsoring employer is excluded from the definition of a ?group health plan? under HIPAA's administrative simplification provisions, which include the privacy and security requirements.
Title IV: Application and Enforcement of Group Health Plan Requirements.
The Plan (the Group Health Plan) is a HIPAA Covered Entity ? not the Plan Sponsor (the employer or labor union or other employee organization). But a Plan Sponsor must ensure its Group Health Plan complies with HIPAA Rules. A Group Health Plan may be fully-insured or self-insured.
The Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) establishes national standards to protect individuals' medical records and other personal health information.
The HIPAA Privacy Rule regulates the use and disclosure of protected health information (PHI) by "covered entities." These entities include health care clearinghouses, health insurers, employer-sponsored health plans, and medical providers.
When you apply for a HIPAA plan, you should provide a Certificate of Creditable Coverage from your last health plan. This is a letter that says how long you have been covered and provides proof that you have had at least 18 months of coverage.
The definition of ?group health plan? is adopted from the statutory definition at section 1171(5)(A), and excludes from the rule as ?health plans? only the few insured or self-insured ERISA plans that have less than 50 participants and are self administered.
The Health Insurance Portability and Accountability Act of 1996; specifies federal regulations that ensure privacy regarding a patient's healthcare information. Truthfulness; not lying to the patient. Never revealing any personal information about the patient. Do no harm to the patient.