Employer records to heatlh information

[mrtoledo]

What is the name of your state?MI

I have health insurance through my employer (large Fortune 500 Company) through a major national insurance company.

What information does/can the insurance company provider to the employer?

Do they see how much was paid on my behalf of medical expenses?
Do they see any type of diagnoses, medication, or specialist seen?

I have tried to read through the privacy policy, and I still am confused.

 

[lkc15507]

Pure supposition, but from your post, I assume that you have a fully insured employer group health insurance plan. If that is the case, your employer has no right to your personal health information (a definition of PHI can be had by searching the Dept of Labor website and the Code of Federal Regulations). That having been said, they do have and will receive information regarding the costs incurred by you and / or any dependents on the plan for a period of time. The insurer will likely question you (and / or dependents) regarding health history in order to establish an estimate of risk. Although the PHI is not / should not be passed to the employer, the ultimate risk determination will affect the employer's premiums overall. I. E. the employer should not / does not know the particulars of your / dependents PHI, yet they will have an idea of the impact of your health's history upon the plan. However, denying current, new, continued, or future employment based on health history is a real "no, no". It happens, frequently, but be aware of your state and federal regs regarding health insurance to guard against improper employer action. lkc15507

 

[cbg]

On the other hand, if your health insurance is a self-insured plan that is ADMINISTERED by the national company, then those people in your HR or Benefits department who administrate the plan do have access to some of the information you describe. However, the law regulates strictly who can have access to it and who can be given the information. Under NO circumstances can just anyone see this info. It does not go to your boss or your supervisor, and it cannot be acessed by your co-workers.

 

[mrtoledo]

Thanks for the info. I beleive our plan is a self-insured plan.

 

[Happy Trails]

I'm from NJ. Hi I read that last post and it was rather interesting. I thought when I clicked on the subject link that it might give me some insight - My question is somewhat related...but not exactly. Can an employer unauthorize an insurance company to not send out employee health insurance policy information that she and her attorney request? If an employer told the insurance company not to send out the requested information, would the insurance company have to abide by their client's wishes?

Because, I have a question with regard to my employers group health insurance plan. (all having to do with disclosure) If an employer implies that there is maternity coverage both by verbal communication and also providing an insurance policy booklet that describes maternity coverage (and coverage for offspring) and the employee finds out after services were rendered that the bills remain unpaid because the insurance company denied the claim on the basis that the "employers excluded maternity coverage", would that not be considered a breach of contract on the part of the employer with regard to the health insurance plan? If an employee gets an answer that her insurance premiums are high because she is of child bearing age when she inquires wouldnt that be a breach of contract if the employer knew all along there was an exclusion on the policy for maternity?

If it is considered as such, what typically happens to the employer? Say for example, the employers were paying half the insurance premium (as the employee earned up to that status in her job), and the employee was still to pay the other half (for coverage she never really had) - and this went on for a good 4 years without employee knowing she had this exclusion on her policy. The premiums were roughly $240 a month. Is the employee entitled to any refund of premiums or a credit of some sort? - or atleast to have the unpaid maternity related bills paid?

The reason I'm interested in this information is because it is closely related to a wrongful termination/pregnancy discrimination situation I find myself in. I appreciate any insight you may have. As I believe this "no maternity coverage" put on this policy is the reason for the termination. Please advise.

**Mrs. Smith, please delete this post and start your own thread. It eliminates any confusion with the original poster's thread.

 

[MrsSmith]

I deleated it as you requested to put it under a "new thread" sorry about the confusion. After deleating it the paragraphs still appeared before your response - so I hope I did it the right way.