Health insurance question

[luvwinnie]

When a company is looking at new providers for health ins. does the company look into what health problems the employees have and what meds they are on?

 

[Maleficent13]

Yes, they do. And the insurance company can base their decisions about whether to offer coverage to the company and/or what premiums to charge based on this information.

FYI, also, in case you didn't know, your HR department personel also know exactly what doctors you see, what your diagnosis are, and what meds you're on (assuming you used your insurance to pay for it).

 

[luvwinnie]

Thanks, Mal. We have no HR dept...very small, just 12 people.

 

[mickeyboat]

When a company is looking at new providers for health ins. does the company look into what health problems the employees have and what meds they are on?

The availability of health information varies from state to state. In NH, small employers (under 50 people) do not have access to the health information of their employees. Policies are written on a "community" standard basis combined with the type of work the employees perform and the ages of the employees.

Employers with over 100 employees can send health questionnaires to their employees and can obtain claims costs of its group.

Employers with 51-99 employees are rated on both a community based system and a claims based system.

Employers must be careful not to use health information on a discriminatory basis. Plus the release of this type of information is now regulated in part by the HIPPA laws.

We used to have a self-insured type insurance policy when I first came to work here. Every month we would receive a statement reflecting the exact amount of claims for each employee.

Denae

 

[4cruisin]

Yes, they do. And the insurance company can base their decisions about whether to offer coverage to the company and/or what premiums to charge based on this information.

FYI, also, in case you didn't know, your HR department personel also know exactly what doctors you see, what your diagnosis are, and what meds you're on.

I'm surprised to hear this. Part of my position at the company I work for involves handling health insurance. We do not self insure. We have no knowledge of our employees medications, doctors etc. Doesn't the HIPAA cover this?

 

[Christine]

I just acquired health insurance for our company of 13 people. The insurance company/broker had each employee fill out a lengthy health questionnaire and we had to send it back to them. They used this information to determine what our rate would be (or if they'd even take us).

 

[caitycaity]

FYI, also, in case you didn't know, your HR department personel also know exactly what doctors you see, what your diagnosis are, and what meds you're on.

that's not true where i work (company of more than 1000 people).

 

[Maleficent13]

I would assume the HR director would fall under "acceptable" people to have this info under HIPAA. I do know for a fact that at my company, she knows what's wrong with everyone, because the insurance company sends her a monthly report. I know this, because she actually was dumb enough to say this while speaking to my manager about an employee issue. She also told my manager that it was all my department's fault our premiums were so high, because we had all the sickies in our department. And then proceeded to tell my manager the ins and outs of several of my employees' problems (including psych diagnosis!!). I was in the manager's office at the time, and she just kept saying to HR, "Lori, I really don't want to know this."

eta: my company employs just under 1,000 people.

 

[zippeedee]

Yes, they do. And the insurance company can base their decisions about whether to offer coverage to the company and/or what premiums to charge based on this information.

FYI, also, in case you didn't know, your HR department personel also know exactly what doctors you see, what your diagnosis are, and what meds you're on (assuming you used your insurance to pay for it).

I'm a Benefits Manager for a company with just under 1000 employees. We see only aggregate data from our health plans, stuff like the total number of prescriptions purchased in each year, the types of drugs, the most prevalent illnesses, etc. HIPAA privacy laws prevent us from seeing any information for an individual employee other than the plan chosen and then number of family members covered. This could of course be different in other states and for very small companies, but in general none of the personal information can be shared.
The health plans have "disruption reports" that they are required to share with other plans we are considering if we bid out for a possible change. This contains hospitals used, doctors seen and claim dollars spent, but is not employee specific.
Employees who apply for Family & Medical Leave (FMLA) also have privacy protection. We see their diagnosis from their doctor, but this information cannot be shared with anyone else, not even their direct supervisor.

 

[4cruisin]

I would assume the HR director would fall under "acceptable" people to have this info under HIPAA. I do know for a fact that at my company, she knows what's wrong with everyone, because the insurance company sends her a monthly report. I know this, because she actually was dumb enough to say this while speaking to my manager about an employee issue. She also told my manager that it was all my department's fault our premiums were so high, because we had all the sickies in our department. And then proceeded to tell my manager the ins and outs of several of my employees' problems (including psych diagnosis!!). I was in the manager's office at the time, and she just kept saying to HR, "Lori, I really don't want to know this."

If she worked for me, she would have been fired immediately. I believe her "spilling her guts" about personal medical information of employees is a violation of the HIPAA laws not to mention very ignorant and morally wrong.

 

[Tigger_Magic]

FYI, also, in case you didn't know, your HR department personel also know exactly what doctors you see, what your diagnosis are, and what meds you're on (assuming you used your insurance to pay for it).

I don't believe this is true in the age of HIPAA. There are very strict guidelines applicable to healthcare providers and other covered entities that dictate when and what may be disclosed. Usually the disclosure must be approved by the patient unless the reason for disclosure falls within the guidelines established by HIPAA. Disclosing your medical information, including which doctors you use, diagnosis information or medications prescribed to a company's HR dept. is not, as far as I can tell, not generally allowed under HIPAA guidelines.

This gov't. website provides extensive info on HIPAA privacy rules -- http://www.hhs.gov/ocr/hipaa/privacy.html

 

[luvwinnie]

If she worked for me, she would have been fired immediately. I believe her "spilling her guts" about personal medical information of employees is a violation of the HIPAA laws not to mention very ignorant and morally wrong.

ITA!!!!

 

[Tigger_Magic]

I would assume the HR director would fall under "acceptable" people to have this info under HIPAA. I do know for a fact that at my company, she knows what's wrong with everyone, because the insurance company sends her a monthly report. I know this, because she actually was dumb enough to say this while speaking to my manager about an employee issue. She also told my manager that it was all my department's fault our premiums were so high, because we had all the sickies in our department. And then proceeded to tell my manager the ins and outs of several of my employees' problems (including psych diagnosis!!). I was in the manager's office at the time, and she just kept saying to HR, "Lori, I really don't want to know this."

eta: my company employs just under 1,000 people.

Whoever released that information to your company and your company are in violation of HIPAA privacy rules. There are severe penalties for unauthorized disclosure of medical records/information to/by an individual including fines up to $250,000 and/or 10 years in prison. The company could also be heavily fined for these violations.

Sounds like your company needs to take a course on HIPAA security.

 

[luvwinnie]

I'd be livid if someone divulged my health information!

 

[oregonmousefan]

I am the Employee Benefits Manager for a company of a little over 1000 people. We self insure our medical plans.

We get basic information (illnesses, prescription usage,etc.) but not on an individual basis. I may know that we have a premature birth that has $500,000 in claims year to date but I don't know who's kid that is or specific circumstances. We don't want to know....if you have a difficult employee and know they have a medical problem, they could say you were being discriminatory for reprimanding them in any way.

 

[oregonmousefan]

Oh...but to answer the original question. Insurance companies looking to underwrite or obtain your plan under their coverage have access to information beyond what I have. They may even bid the business carving out a few highly expensive cases/people.

 

[luv2nascar]

I work for a large insurance company that insures all types of plans small group to large group. We will not release any medical information to any one at the employer not limited to doctor's names, diagnosis, prescriptions, etc. HIPAA prevents this unless employee signs an authorization to release such information. A lot of employers will not submit claims for employees without seeing the forms etc (I work in disability) employer information is necessary. Employees need to be better informed that they do not have to release info to employer and employers are legally wrong to demand to know this info.

 

[rascalmom]

DH owns a very small business ( 7 employees). The only thing we get from the insurance company is the bill for the premiums. It lists the employee name & the number of dependents covered.

At enrollment, the employees do have to fill out a questionairre for the insurance company. The employee can send it in themself. The employer &/or co-workers doesn't ever see it.

It's my understanding that insurance companies do share claim information with other insurance companies - I'm sure they have to adhere to HiPAA regs, but it is inherent in their business that they know what kind of risk they are possibly contracting to cover.

 

[figment52]

Yes, they do. And the insurance company can base their decisions about whether to offer coverage to the company and/or what premiums to charge based on this information.

FYI, also, in case you didn't know, your HR department personel also know exactly what doctors you see, what your diagnosis are, and what meds you're on (assuming you used your insurance to pay for it).

That is not always true. It depends on the size of the group. Insurance carriers do not track groups of certain sizes and "area rate" them rather than group rate them. In fact, HIPPA regulates disclosure of information so strictly that some carriers will not even discuss claims relating to one spouse with the other spouse without a release from the first party.

Specific information information is not shared as freely as it used to be. IF you are a large enough group they may ask for medical disclosure statements from the prospective participants ot they will request loss runs form the prior carrier/current.

The exception to this is if the company self insures and they administer the payments to the providers themselves. Even with all that HIPPA requires for confidential information and access, those companies hire a third party administrator to handle those claims.

 

[Tanuki]

HIPAA just protects your privacy if you don't sign a release of information.

Lots of applications for all sorts of insurance have the release for you to sign right there in the application.