Q&A: How HIPAA Affects You

Q: How do HIPAA’s nondiscrimination rules affect an employer?

A:  The Health Insurance Portability and Accountability Act (HIPAA) prohibits discrimination by group health plans and insurers based on factors related to health status. HIPAA nondiscrimination rules affect employers in various ways:

  • HIPAA does not allow a group health plan to deny an individual eligibility for benefits or to charge a higher premium than is required of a similarly situated individual based upon health factors such as:
    • Health status or medical history
    • Medical condition (physical or mental)
    • Receipt of health care
    • Claims experience
    • Genetic information
    • Evidence of insurability
    • Disability

The HIPAA Privacy Rule does not directly regulate an employer sponsoring a group health plan; only the health plan is directly regulated. However, where the plan sponsor has access to protected health information (PHI) related to the administration of the health plan, it must comply with the requirements of the HIPAA Privacy Rule. A plan sponsor’s access to enrollment applications and disenrollment information alone does not qualify as having access to PHI for the purposes of the rules.

  • HIPAA does not allow group health plans to require employees to pass physical exams in order to be eligible for health insurance coverage.
  • HIPAA does not allow group health plans to delay an individual’s effective date for coverage because he or she is confined to a hospital or because he or she is not actively at work.
  • HIPAA states that group health plans may include benefit limitations within their plans as long as the limitations apply uniformly to all similarly situated individuals.
  • HIPAA states that group health plans may not charge employees higher premiums or deny them health insurance coverage based upon the employees’ participation in dangerous or hazardous activities.
  • HIPAA permits group health plans to treat individuals with adverse health factors more favorably.


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The information provided is for informational purposes only and does not constitute legal advice. The information above contains only a summary of the applicable legal provisions and does not purport to cover every aspect of any particular law, regulation or requirement. Depending on the specific facts of any situation, there may be additional or different requirements. This is to be used only as a guide and not as a definitive description of your compliance obligations.