Covered+Entities

=Covered Entities= Covered entities are defined in the HIPAA rules as; (1) health plans, (2) health care clearinghouses (3) health care providers who electronically transmit any health information in connection with transactions for which HHS has adopted standards

Health Plans
//A Health Plan is defined as an individual or group plan (such as a family plan) that provides or pays the cost of medical care. There are a few exceptions to this. This applies specifically to include many types of organizations and government programs as health plans.//

This includes:
 * Medical, Dental, and Vision Plans
 * HMOs
 * Medicare and Medicaid
 * Medicare+Choice and Medicare Supplement Insurers
 * Long-Term Care Insurers (excluding nursing home fixed-indemnity policies)
 * Veterans Health Plans
 * Company Health Plans

Exceptions include:
 * A group health plan with less than 50 participants that is administered solely by the employer that established and maintains the plan is not a covered entity;
 * Government-funded programs whose principal purpose is not providing or paying the cost of health care;
 * Government-funded programs whose principal activity is directly providing health care or the making of grants to fund the direct provision of health care; and,
 * Certain types of insurance entities such as those providing only workers' compensation, automobile insurance, and property and casualty insurance.

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Health Care ClearingHouses
//Entities that process nonstandard health information they receive from another entity into a standard (i.e., standard electronic format or data content), or vice versa.//

This includes:
 * Billing Services,
 * Repricing Companies,
 * Community Health Management Information Systems, and,
 * Value-added networks and switches if these entities perform clearinghouse functions.

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Health Care Providers (who electronically transmit any health information in connection with transactions for which HHS has adopted standards)
//A provider of services, a provider of medical or health services, and any other person or organization who furnishes, bills, or is paid for health care in the normal course of business.//

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Web Sources
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