Employee privacy vs. wellness
November 5, 2008 by Bill MeltzerPosted in: HIPAA, Special Report, Wellness
When it comes to obtaining and using employees’ health info, your firm’s plan has more power than you may think.
Under HIPAA, your plan is allowed to obtain health info for the purpose of controlling your health costs. And there are a host of legal uses of that info for that one purpose.
Questions you can answer
Your plan is entitled to obtain and review a sampling of people’s personal health info to answer all of the following plan cost-related questions:
- Are employees getting the right treatment for their health conditions?
- Which network doctors aren’t communicating treatments with each other, wasting resources?
- Are employees compliant with their prescription drugs?
In short, you’re allowed to use the info to more accurately predict upcoming claims and costs in the short-term future. What you can’t do with the info is make any employment-related decisions with it.
Experts debate if the prohibition includes charging smokers or other at-risk populations higher premiums. But you can always use it when shopping the cost-effectiveness of different health plans or for making your wellness program even stronger.
Wellness program implications
Under HIPAA and ERISA, you’re allowed to use health data as the starting point for having employees contacted regarding their health issues. Based on the info you obtain, you can hand-pick people for educational mailings about specific health issues.
Your wellness program manager is allowed to find out if an employee has a certain health problem (such as asthma or diabetes) and hasn’t sought a program to treat that issue.
Reminder: If you offer financial incentives as part of your wellness program, be aware that HIPAA’s non discrimination rules require you to wipe the slate clean each plan year.
Legally, it’s still the safest policy to stay hands-off personal health info when it doesn’t relate to certifying FMLA or accommodating ADA. But it’s good to know HIPAA’s privacy rule is usually on your side in the battle to control health costs.
Tags: Wellness, wellness programs
November 6th, 2008 at 1:26 pm
Its too bad that employers can’t get this information without identifying the specific party. If they then determine any of the issues discussed in the article, only then should they be able to find out the person’s name. Just imagine an employer determining that an employee is being treated for HIV. It may be due to the employee being homosexual or because he was infected by someone not practicing safe sex. Regardless of the law, it would be hard to convince me that there wouldn’t be a strong possiblity of being misbranded as gay and having repurcussions as a result.
November 6th, 2008 at 2:12 pm
I don’t want to know any personal health information. When insurance renewal comes up and I have to complete the forms for insurance carriers, I must give them health information on our employees. If I don’t have the information, I can’t report it. I only report those health conditions that I am aware of. In this case, ignorance is bliss.
November 6th, 2008 at 2:38 pm
I would prefer not to know personal health information also. Many of our employees feel comfortable talking with HR and at times we must ask them to refrain. As mentioned, if it isn’t necessary for FMLA or ADA, I don’t want to know.
November 6th, 2008 at 4:01 pm
Ignorance may be bliss, but with costs going up, I think it is valuable to know certain things. The law is pretty clear, if you use the info to make an employment decision, then you are in violation. I would like to be able to get employees into a diabetic program if possible. It is far cheaper to manage diabetes than it would be to have someone go into a diabetic shock episode.
November 6th, 2008 at 4:48 pm
We are just starting a wellness program, and at this time NOT offering any incentives. We’re planning group activities that the company will assist with payment. Do we have to worry about HIPPA or any other privacy acts?
November 6th, 2008 at 4:50 pm
Hey Kraut,
You say that the possibility of being “misbranded as gay and having repurcussions as a result.” Where do you live, in a RED State? Where I work, being gay is a GOOD thing.
We’ve got to get over this BACKWARD thinking people!
November 6th, 2008 at 4:58 pm
I have to agree ignorance is bliss and if you knew something negative on an employee it may not always be easy to overlook it when making decisions.
November 7th, 2008 at 2:05 pm
Let’s all get real here!
It may not matter to Gaylord to be Gay and Ignorance is Bliss, but as RH says; it may not always be easy to overlook it when making decisions.
If the company wants or has to save money in its health plan, I am confident that it will look at how to cut those costs with those employees. HIPPA’s privacy was suppose to protect employees. Now there is a loophole. That loophole has always been there, and only the truly savy knew about it till now.
So, if the employer can look to your person medical records, they can and will terminate you regardless if you are a good Gay or a bad Gay, a good diabetic or a bad diabetic. It hogwash to think, that there is any caring whether or not you are in a diabetic program. Get real.
Just another way to subject employees to behind the scene harrasment.
November 7th, 2008 at 8:51 pm
Having been on the HR side, and dealing with insurance cost factors, I understand the complexities of making those decisions. From the employee side, I am one of those individuals who now must take maintenance medicine (probably for the rest of my life), plus semi-annual checkups, and have to consider what the employer must do to keep their healthcare costs down. Truly, it is a double-edged sword.
November 11th, 2008 at 3:27 pm
When compassion and cost come head-to-head, compassion loses. I’ve been in HR for over 20 years and have reported directly to business owners or CEO’s / presidents during most of that time. Most like to think they are caring individuals, but when it costs them money, the care and compassion vanish. Even trying to promote a more balanced thought process is difficult. For this reason, I don’t think its a good idea to have access to individual employee health data.
Costs continue to rise and I know this has to be managed. However, people have ALWAYS gotten sick and have used their insurance, if available, so USING the insurance is not necessarily the issue. It’s the cost of various procedures, some of which weren’t available in the past and which are very expensive. I don’t think the problem is so much the employee as it is the medical field and the insurance industry. I do believe promoting wellness (preventative care) is positive, is less expensive in the long run and for that reason, I applaud wellness efforts that aren’t punitive. Penalizing an employee for needing health care just doesn’t seem like the answer to me. I wish I had a solution…it’s a very complex issue with many sides and variables. I’m certainly not qualified or smart enough to fix the problem. It’s going to take a major overhaul and in the meantime, those of us who have access to this kind of privileged information need to be very careful as to how we use it.