All WRS Employers
Vol. 20, No. 14
September 26, 2003
DETF Makes Changes to Comply With Health Insurance Portability
and Accountability Act (HIPAA)
Through this Employer Bulletin, the Department of Employee
Trust Funds (DETF) hopes to supplement what you may already know
about the Health Insurance Portability and Accountability Act (HIPAA)
and outline some of the HIPAA compliance efforts going on within
What is HIPAA?
Congress enacted HIPAA at the request of the health industry. The
primary goal underlying one HIPAA effort is to simplify and streamline
the healthcare claims and payment process by implementing national
standards. The three components of this "administrative simplification
rules" effort, are: Electronic Data Transaction Standards,
Privacy, and Security.
What is DETF Doing?
DETF has identified itself as a "covered entity" by virtue
of the Group Insurance Board's self-insured health insurance
plans administered by the Department. As a covered entity, the Department
must comply with the applicable HIPAA regulations. Some of the changes
we have made in response to HIPAA include:
- The Health Insurance Application forms (ET-2301 and
ET-2302 - for Graduate Assistants) were amended (see below).
- The Health Insurance Complaint Form (ET-2405) was amended
to be HIPAA compliant. The form now includes an authorization
for DETF staff to work with the health plan and must be completed
by the participant in order to initiate a complaint.
- A Notice of Privacy Practices was mailed to all members
of the Standard Plans in April 2003 and is posted on DETF's
Web site. In addition, participants covered by a Health Maintenance
Organization (HMO) received the Notice from their HMO.
What Does HIPAA Mean to Employers?
As a result of HIPAA, health plans cannot release any information
to an employer about a participant's health insurance claims
unless they have a signed authorization from the participant. This
may affect employers who assist their employees with health insurance
claim issues. If you encounter this situation with a health plan,
you can either obtain an authorization from the employee, or direct
them to the DETF ombudspersons for assistance.
Employers should exercise caution when discussing sensitive health
issues concerning their employees. Remember to provide only the
minimum necessary information. In addition, take steps to ensure
you do not use employees' protected health information for
What Specific Changes Were Made to the Health Insurance
If you have any questions about the employers' role in HIPAA,
please contact Steve Hurley at (608) 267-2354 or Kari Jo Zika
at (608) 266-1423. Questions related to health insurance eligibility
or enrollment should be directed to the Employer Communication Center
at (608) 264-7900.