A covered entity is an entity required to comply with the HIPAA Administrative Simplification provisions. If an entity is a covered entity for any purpose under HIPAA Administrative Simplification, it is a covered entity for all purposes under HIPAA - meaning it must comply with not only the Privacy Rule, but also the Electronic Transactions Rule, the Security Rule, etc.
According to HIPAA Privacy and Security, there are three types of covered entities:
[45 CFR § 160.103.]
Employers need to determine if they offer a covered health plan or if they offer any health services on-site that qualify as a covered health care provider.
Generally, a covered health plan is an individual or group plan that provides, or pays the cost of, medical care. See the flowchart image to help you determine if you are a covered health plan. [45 CFR § 160.103.] Medical care is defined as amounts paid for:
[42 USC § 300gg-91(a)(2).]
The term health care provider is defined broadly. See the flowchart image to help you determine if you are a health care provider. It includes:
[45 CFR § 160.103 (definition of "health care provider").]
The last part of the definition in particular is meant to be functional – a person is a health care provider if the activities in which the person is engaged meet the definition of health care. It is, therefore, important to know the meaning of the term "health care."
Regarding the treatment of protected health information, Covered Entities shall use all appropriate safeguards to prevent use or disclosure of Protected Health Information received from, or created or received on behalf of, the Covered Entity other than as provided for in the Business Associate Agreement or as required by law.