What is the Origin of Self-Funded Plan Data Governance?

This governance structure is necessitated by the specific legal status of a self-funded plan under the Employee Retirement Income Security Act (ERISA) and the requirements of the HIPAA Privacy Rule, which mandate a legal firewall between the plan and the employer's management functions. This dual legal framework creates unique data handling challenges.

What is the Mechanism of Self-Funded Plan Data Governance?

Effective governance involves appointing a dedicated privacy official, establishing clear administrative firewalls, and ensuring that the employer only receives de-identified summary health information for plan administration purposes. This mechanism ensures that the employer's business units do not have access to individual health data, such as hormonal lab results, thereby preventing the use of this information for discriminatory purposes.

Self-Funded Plan Data Governance ∞ Area

Self-Funded Plan Data Governance

Meaning

Self-Funded Plan Data Governance refers to the internal policies, procedures, and administrative oversight mechanisms established by an employer that sponsors a self-funded health plan to manage the use, storage, and disclosure of employee protected health information (PHI) while strictly complying with HIPAA and ERISA. This governance is crucial because the employer, as the plan sponsor, takes on many of the legal responsibilities of a Covered Entity, necessitating a clear separation of data functions. The governance structure must prevent PHI from being used in employment decisions.