What should I disclose to potential health insurance carriers?

When pricing and comparing group health insurance, many insurance companies will require certain information about your employees or "group." This often includes personal information such as age and gender, but may also include medical history depending on the size of the group and the laws in the state in which the insurance will be issued. Generally, individual employee names and Social Security numbers are not disclosed, but employee numbers or IDs are often given. Sometimes carriers ask for group risk information, which is a questionnaire answered by the employer to describe aggregate risk the employer may be aware of, such as conditions, diagnoses and treatments, but it does not provide identifiable or specific employee information. This type of form is common for larger group health plans.

Alternatively, in many states, small group plans (fewer than 50 eligible employees) may be required to provide detailed medical questionnaires from employees to obtain rates through medical underwriting. Whether required by state insurance laws or simply requested by a carrier, this information is considered protected health information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA), and precautions must be made to protect the privacy of this information. As a result, employers should have a Business Associate Contract (BAC) with the brokers, vendors or carriers they deal with. A broker, vendor or carrier will typically ask the employer for a BAC, but if they do not, the employer should initiate this agreement because the BAC protects both parties equally.