Can Employers Check Your Medical Insurance?

by Eric Feigenbaum; Updated September 26, 2017
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The link between employers and health insurance can leave employees feeling a little uneasy. After all, if an employer helps pay for health insurance, it stands to reason it has the right to know about how it's used. According to federal law, employers can't look at individuals' medical records but are allowed reports of aggregate health insurance use.

HIPAA

The federal Health Insurance Portability and Accountability Act provides vast privacy rights for patients. Only patients, appropriate medical personnel and insurance company officials as required can view medical records. Even patients' families don't have the right to medical records or information without patient consent. Accordingly, neither medical providers nor insurance companies can share information about an employee's health with an employer.

Financial Information

Employers are allowed to monitor health insurance utilization. That means an employer can see the amount of claims being charged against its health insurance plan. Insurance companies can share both aggregate charges for the entire workforce as well as claims per employee. In this way, an employer can know that an employee has been receiving a larger than normal amount of health care -- but not the details involved, including the names of providers and facilities.

Reasons

Increased health insurance utilization can lead to higher premiums for an entire company. Employers monitor health insurance use to keep an eye on whether insurance plans meet employee needs and to see how insurance use will affect benefits costs. High insurance utilization may force employers to shop for new health plans to keep coverage affordable.

Disclosures

In some circumstances, employees choose to share medical information with employers. This is perfectly legal. For example, an accident leading to a disability may cause an employee to request special accommodations from an employer. Similarly, taking leave or short-term disability because of a complex or serious medical condition usually requires employees to share personal information with employers. Most obviously, it's hard to request a maternity leave without giving away some medical information. Additionally, HIPAA does not forbid employers from requesting pertinent medical information that may be necessary to leaves, administration of a benefits plan or reasonable accommodation. However, release of such information requires employee authorization.

About the Author

Eric Feigenbaum started his career in print journalism, becoming editor-in-chief of "The Daily" of the University of Washington during college and afterward working at two major newspapers. He later did many print and Web projects including re-brandings for major companies and catalog production.

Photo Credits

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