Frequently Asked Questions

HIPAA is the acronym for Health Insurance Portability and Accountability Act of 1996 that sets out Regulations/Standardizations for Privacy, Portability, Administrative Simplification for health plans.

Many insurance carriers have compiled "HIPAA Privacy Guides" for member reference. Additionally, they require specific forms to be completed and signed to authorize release of personal/protected health information to Kistler Tiffany Benefits personnel to help you with your questions about your health plan membership.

• Department of Health and Human Services
  TIP - Select your search in the category "Privacy of Health Information/HIPAA"
• The Centers for Medicare & Medicaid Services (CMS)
• PUBLIC LAW 104-191 AUG. 21, 1996 HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996

COBRA is the acronym for The Consolidated Omnibus Budget Reconciliation Act. COBRA gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage up to 102 percent of the cost to the plan.

Use this weblink to get to the US Department of Labor's website to review the details concerning COBRA. Some states have laws that apply to groups that fall below the threshold for COBRA to apply. Refer to your local department and insurance for further guidance.

Employers

• Know when this law applies to your organization and employees enrolled in your group
  health plans.
• Understand your responsibilities and provide timely and accurate "in the door" and "out the door" notices to your employees and their dependents. Be aware of what events may cause the need for a COBRA notice to be sent.
• Create and use a solid internal procedure to handle COBRA issues or outsource the whole process to a professional organization.
• Keep current with the changes in the law and administration guidelines from the US Department of Labor. There are cash penalties for non-compliance.
• Watch out for COBRA's interaction with other employee protection laws & other employee benefits programs.

Consumers

• Understand your rights as a continuee and follow the instructions on your COBRA notice. If you elect to continue coverage under COBRA law remember to pay your premium in a timely manner and keep your employer informed of any address changes.

The terms "Drug Formulary List", "Preferred Drug List" and "Select Drug List" are health program labels with similar meanings. A Drug Formulary is a list of medications to help guide physicians and pharmacists to select the medication that provides the appropriate treatment for the best price.

The Drug Formulary is a cost containment feature associated with many health plans that:

• is used as a guide for physicians in prescribing quality, cost-effective medications
• is unique to each health plan
• is created/compiled by panels of physicians and pharmacists
• can change periodically
• applies to medications that are dispensed in both retail and mail-order pharmacies

The most current formulary list is typically available on a carrier's website for member and provider reference. The formulary contains a wide range of generic and brand-name preferred medications that have been approved by the U.S. Food and Drug Administration.

A Preferred Drug List (PDL) provides members, physicians and pharmacists with the necessary information to maximize the drug benefit coverage and minimize the member's financial contribution.