Can health plans disclose PHI to employers?

The correct answer is that health plans can disclose protected health information (PHI) to employers only under specific conditions, such as obtaining written consent from the individual or when required by law.

HIPAA (Health Insurance Portability and Accountability Act) establishes strict guidelines regarding the use and disclosure of PHI. Generally, health plans are prohibited from disclosing PHI to employers without explicit consent from the individual whose information is being disclosed. This aligns with HIPAA's primary goal of safeguarding patient privacy and ensuring that individuals have control over their health information.

For instance, if an employee needs their health information to be shared for purposes such as accommodations under the Americans with Disabilities Act (ADA) or for wellness programs, the employer may request this information, but the health plan must first ensure that it has the necessary written authorization from the individual. Additionally, there are scenarios in which disclosures are mandated by law, such as for certain workers' compensation claims or public health reporting, which allows for exceptions to the general rule prohibiting disclosures to employers.

This ensures that while there can be necessary interactions between health plans and employers for administrative or legal reasons, there are protections in place to maintain the privacy and confidentiality of individuals' health information.