Personal Representative

Op10.03-23 Personal Representative

Complies with the Administrative Requirements of the Health Insurance Portability and Accountability Act of 1996. 45 CFR Section 164.502(g)

Policy

The Employee Benefit Plan recognizes the personal representative of a participant in accordance with the Privacy Rule.

Procedure

  • The personal representative of a participant is a person who has the right to make decisions related to the exercise of a person’s privacy rights as though they were the participant.
  • The following people qualify as a participant’s personal representative:
    • The individual subscriber or plan participant (e.g. individual from whom payroll deductions are taken for coverage) for his/her covered dependents (including his/her spouse and child(ren),
    • An individual under applicable law who has the authority to act on behalf of an adult or an emancipated minor in making decisions related to health care (e.g. has health care power of attorney),
    • The parent, guardian, or other person acting in loco parentis of an unemancipated minor, or
    • The executor of the estate of a deceased participant
  • The Employee Benefit Plan may elect not to treat a person as the personal representative of an individual if it has a reasonable belief that:
    • The individual has been or may be subjected to domestic violence, abuse, or neglect by such person or treating such person as the personal representative could endanger the individual, and
    • The Employee Benefit Plan decides in the exercise of professional judgment that it is not in the best interest of the individual to treat the person as the individual’s personal representative.

Effective Date: April 14, 2003