The U.S. Department of Health and Human Services (HHS) is requiring all self-insured health plans to obtain a Health Plan Identifier number (HPID) as part of its compliance efforts under the Health Insurance Portability and Accountability Act (HIPAA). This number will be used in the future so that the plan, or its third-party administrator (TPA), can (i) certify the plan’s compliance with HIPAA (beginning in late 2015), and (ii) identify the plan in certain electronic transactions (beginning in late 2016). Any plan that pays $5 million or more in annual claims must obtain an HPID by next Wednesday, November 5. (For smaller plans, the deadline is November 5, 2015.)
If a plan is fully insured, the insurer will apply for the HPID. But if the plan has a self-funded component (e.g., prescription drug coverage), the plan will need an HPID. In determining if a plan has a self-funded component for this purpose, generally the flexible spending accounts and retiree health reimbursement accounts can be disregarded.
Check with the plan’s TPA to see if it has applied for an HPID on behalf of the company’s group health plan(s). If not, an HPID must be obtained for each “controlling plan”, which means a single plan and includes a “wrap” plan with sub-parts that files a single Form 5500 (but only if the wrap plan has at least one self-funded component). Alternatively, an HPID may be obtained for a “subhealth plan” (e.g., a self-insured program that is part of a wrap plan).
For employers with wrap plans that file a single Form 5500, it may be easier to obtain a single HPID for the entire plan, including all of the self-insured programs or “subhealth plans” – even if there are fully insured programs within the wrap plan (the insurer will take care of anything fully insured). (When applying for the HPID, identify the plan as “[NAME OF PLAN] – self-insured programs.”) If separate Forms 5500 are filed for multiple health plans, an HPID is needed for each plan that has a self-funded health plan component.
To obtain an HPID, an account has to be created in the CMS Enterprise Portal: (https://portal.cms.gov/wps/portal/unauthportal/home/). Initially, an individual must sign up as a “Submitter” (not an Authorizing Official). The process requires submission of personal information (e.g., social security number) for the individual. Once enrolled, the Submitter can apply for the plan’s HPID, edit the application, view the application audit history, and submit feedback. For a one-page instruction guide that may be useful, visit: http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/Affordable-Care-Act/Downloads/HPIDQuickGuideSeptember2014.pdf.