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    HIPAA Regulations: The Administrative Requirements: Group Health Plans - § 164.530(k)

    As Contained in the HHS HIPAA Rules

     

    HHS Regulations
    The Administrative Requirements: Group Health Plans - § 164.530(k)

     

    (k) Standard: Group health plans. (1) A group health plan is not subject to the standards or implementation specifications in paragraphs (a) through (f) and (i) of this section, to the extent that:

    (i) The group health plan provides health benefits solely through an insurance contract with a health insurance issuer or an HMO; and

    (ii) The group health plan does not create or receive protected health information, except for:

    (A) Summary health information as defined in §164.504(a); or

    (B) Information on whether the individual is participating in the group health plan, or is enrolled in or has disenrolled from a health insurance issuer or HMO offered by the plan.

    (2) A group health plan described in paragraph (k)(1) of this section is subject to the standard and implementation specification in paragraph (j) of this section only with respect to plan documents amended in accordance with §164.504(f).

     

    HHS Description
    The Administrative Requirements: Group Health Plans

     

    We add a new provision (§ 164.530(k)) to clarify the administrative responsibilities of group health plans that offer benefits through issuers and HMOs. Specifically, a group health plan that provides benefits solely through an issuer or HMO, and that does not create, receive or maintain protected health information other than summary health information or information regarding enrollment and disenrollment, is not subject to the requirements of this section regarding designation of a privacy official and contact person, workforce training, safeguards, complaints, mitigation, or policies and procedures. Such a group health plan is only subject to the requirements of this section regarding documentation with respect to its plan documents. Issuers and HMOs are covered entities under this rule, and thus have independent obligations to comply with this section with respect to the protected health information they maintain about the enrollees in such group health plans. The group health plans subject to this provision will have only limited protected health information. Therefore, imposing these requirements on the group health plan would impose burdens not outweighed by a corresponding enhancement in privacy protections.