The business of insurance, including health insurance, has traditionally been regulated at the state level. States license entities that offer health insurance coverage and have established laws that control their structure, finances, and obligations to the people that they insure. However, a number of federal laws also have an impact on priva
Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. Appendix M. Glossary
Accountable Care Organization (ACO)
Although the majority of Americans with health insurance obtain their coverage through group health plans offered through their employers, many individuals obtain their coverage through the nongroup (or individual) insurance market. Currently almost 18 million persons, or almost seven percent of the United States nonelderly (under age 65) popula
Improving the Coordination of Services for Adults with Mental Health and Substance Use Disorders: Profiles of Four State Medicaid Initiatives. Appendix C. Massachusetts State Profile
This state profile also available at: http://aspe.hhs.gov/pdf-report/improving-coordination-services-adults-mental-health-and-substance-use-disorders-massachusetts-state-profile A. Program Description Overview
Personal Privacy in an Information Society. Government Access toPersonal Records and "Private Papers"
Discussion of the need to protect individuals from threats to personal privacy often conjures up ominous images of government agents conducting surreptitious investigations and compiling dossiers. Such images come forcefully to mind when one is concerned, as the Commission is, with preventing improper inquiry into and disclosure of records about i
The Commission considered several ways in which its medical-record recommendations might be implemented and enforced. The alternatives considered ranged from a wholly voluntary approach to Federal legislation which, like the 1974 Drug Abuse and Alcoholism statutes, 49 would make compliance with the recommendations a requirement attached to the di
In the early part of this century, physicians, most of them practicing alone, delivered 85 percent of all medical services in the country.
With a few important exceptions, the Commission's specific recommendations on record keeping in the employee-employer relationship also embody a voluntary scheme for resolving questions of fairness in the collection, use, and dissemination of employee records. The reasons for not recommending statutory implementation of many of these recommendatio
In a small organization the various items of information maintainedabout an employee are frequently mingled in one file, and the custodian ofthe file may perform a number of loosely related record-keeping functions.In a large organization, on the other hand, the need to deal in a consistentway with large numbers of employees, and to match applican
1 American Council of Life Insurance, Life Insurance Fact Book, (New York: American Council of Life Insurance, 1976), p. 9. 2 Health Insurance Institute, The Source Book of Health Insurance Data 1974 - 1975, (New York: Health Insurance Institute, 1975), p. 19. 3 American Council of Life Insurance, op. cit., p. 38. 4 Automobile I
Individual: any natural person who is a past, present, or proposed named or principal insured (including any principal insured under a family or group policy or similar arrangement of coverage for a person in a group), policyowner, or past or present claimant. Insurance Institution:
The Commission's approach to the problems described in this chapter has been to focus on strengthening and balancing the relationship between the individual insurance applicant, policyholder, or claimant and the insurance institution with whom he deals. As indicated at the outset, the Commission's recommendations have three objectives: (1) to c
Personal Privacy in an Information Society. Current Legal Restraints on Record-keeping Practices. State Insurance Regulation
The primary regulatory mechanisms for overseeing the activities of insurance institutions are at the State level. State regulation has developed around two basic aims: (1) maintaining the solvency of individual insurance companies; and, (2) assuring fair business practices and pricing. Although interest in the record-keeping practices of insurance
Because of their acknowledged dependence upon information about individuals, insurance institutions are reluctant to deprive themselves of inexpensive access to it. There are few restrictions within the industry on the sharing of personally identifiable information or on obtaining it from sources outside the industry. This is true of insurance ins
In contrast to most life insurers, a property and liability insurance company has a ready market among people concerned about the replacement cost of tangible assets or about protecting themselves against liability claims brought by others.
Life and health insurers and their agents have different reasons for collecting and using information about individuals than property and liability insurers. In the first place, people often have to be persuaded to buy life insurance, whereas there is a ready market for property and liability coverage. Moreover, because life insurance is often sol
There are essentially two types of insurance companies: stock companies owned by shareholders and mutual companies owned by policyholders. (Blue Cross and Blue Shield are nonprofit associations which policyholders join.) Although the largest life insurance companies are of the mutual type, the total amount of life insurance protection in force is
The activities of the nation's 4,700 insurance companies touch the lives of all Americans in a variety of ways. Two out of three Americans have life insurance protection; 1 90 percent of the civilian population under age 65 is covered by individual or group health insurance policies; 2 and 15 million are covered by the pension plans that life in
The Commission's findings clearly reveal an overwhelming imbalance in the record keeping relationship between an individual and an organization, and its policy recommendations aim at strengthening the ability of the individual to participate in that relationship.