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What Information does a Employer get from a drug plan?
Oct 15, 2004

Hello, I'm a Canadian Employee of a small (9 employee) person division of a smaller (400 employees)of a USA based company. I've recently started HIV Meds, I called what I thought was the insurance company but it turns out they are some sort of middle man. I have found out that my plan is self funded, whatever that means as I've never heard that term before in regards to insurance. I have since found out that the cheques for my drug benefits are issued by this middle man and sent to my companies head office for signature. I'm ver very concerned that everyone will soon know my HIV status and i will be fired. Am I worrying to much about this or not? I know in Canada the employer is only entilted to know the dollar value of the medicalclaim not the actual drugs consumed. Is this the same in the USA? Also what information will my employer have available to them from this third party company?

Response from Ms. Franzoi

With the new HIPAA regs, your health information is protected. The employer only has a right to see what is considered protected health information (PHI) to the extent it is necessary to adminster the plan. It sounds like a third party administrator (TPA) adjudicates the claims and draws the checks on an account funded by the employer (self-insured plan). Most likely, the person signing the checks merely signs a large stack of checks. I wouldn't worry about this. It would illegal for the employer to use this PHI for any purpose other than administering the plan. The employer could not disclose your status to anyone.

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