The Privacy Regulation was designed to provide rights and protections with regards to an individual’s health information. Companies affected by the Privacy Regulation include self-funded group health plans. Fully insured health plans include maximum liability and minimum premium accounts.
Wellmark has sent its enrolled fully insured group health plans important information about:
Important messages include:
How Wellmark Can Assist Enrolled Fully Insured Group Health Plans
An individual may request his/her "designated record set" (DRS). The DRS includes information collected on or after April 14, 2003, and is used to make health care decisions or determine whether an insurance claim will be paid, including:
The DRS includes all health information records maintained by Wellmark, including enrollment applications, attending physician statements and all claims-related documentation for a period of six years (starting April 14, 2003).
The HIPAA-AS Privacy Rule require Wellmark to accommodate an individual's request for a copy of his/her DRS.
For an insured health plan, Wellmark will charge the member a cost-based fee for each request.
The fee will be required at the time the request is submitted.
The HIPAA-AS Privacy Rules require Wellmark to provide an accounting of the disclosures of an individual's protected health information, if requested, over the previous six years starting April 14, 2003.
Wellmark is not required to account for disclosures that occur due to normal payment and health care operations.
Wellmark will provide the first accounting in a 12-month period without charge to the member.
For an insured health plan, the first disclosure accounting will be provided without charge.
For each subsequent request in a 12-month period, Wellmark will charge the member a cost-based fee for each request.
The fee will be required at the time the request form is submitted.