Proposed Revisions, Federal Register, 3/27/2002

Existing Language, Final Rule, 12/28/2000

§ 164.504 Uses and disclosures: Organizational requirements.

§ 164.504 Uses and disclosures: Organizational requirements.

(f)(1)Standard: Requirements for group health plans.

[no substantive change in (i) and (ii)

(f)(1)Standard: Requirements for group health plans.

(i) Except as provided under paragraph (f)(1)(ii) or (iii) of this section or as otherwise authorized under § 164.508, a group health plan, in order to disclose protected health information to the plan sponsor or to provide for or permit the disclosure of protected health information to the plan sponsor by a health insurance issuer or HMO with respect to the group health plan, must ensure that the plan documents restrict uses and discloses of such information by the plan sponsor consistent with the requirements of this subpart.

(ii) The group health plan, or a health insurance issuer or HMO with respect to the group health plan, may disclose summary health information to the plan sponsor, if the plan sponsor requests the summary health information for the purpose of :

(A) Obtaining premium bids from health plans for providing health insurance coverage under the group health plan; or

(B) Modifying, amending, or terminating the group health plan.

[add new (iii) to clarify that that plans, issuers, HMOs as appropriate are permitted to disclose enrollment or disenrollment information to a plan sponsor without amending plan documents.]

(iii) The group health plan, or a health insurance issuer or HMO with respect to the group health plan, may disclose to the plan sponsor 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 to the plan sponsor.