What Employers Need to Know about Healthcare and Privacy

As an employer, you are entrusted with a lot of personal information about your employees. This is especially true when it comes to their healthcare. You provide their health insurance plan, and you are the one who will need to obtain health information in case of a work-related injury, or if your employee requests medical leave or accommodation for a disability. All of this information is confidential, but many employers are unsure what their obligations are when it comes to protecting their employees’ privacy. The Health Insurance Portability and Accountability Act (HIPAA) is what regulates how private health information is treated, but you may be surprised to know that HIPAA doesn’t always apply to employee health information that is maintained by an employer.

What Is HIPAA?

The Health Insurance Portability and Accountability Act, or HIPAA, was established in 1996 as technology was advancing and medical records were beginning to be kept, accessed, and transferred digitally. HIPAA provides federal protection for personal health information, including medical records, conversations regarding medical treatment, and billing information related to a patient’s healthcare. 

yellow folder with confidential in the middle of it in red.

In the workplace, the main way that HIPAA is applied pertains to your employees’ right to privacy. The HIPAA right to privacy rule gives employees:

  • The right to authorize disclosure of their health records
  • The right to request or inspect a copy of their health records
  • The right to have mistakes corrected at any time

HIPAA rules surrounding employee health information are balanced, and they do not mean that you can never ask for or obtain any medical information about your employees – you just need to get it in the right way, and protect it once you have it. 

HIPAA specifically says that its rules apply to what are known as “covered entities,” which are insurance companies and healthcare providers, or any other organization that transmits medical records electronically. These “covered entities” need to be HIPAA compliant. For you, as an employer, HIPAA applies to your request for information from those covered entities. What this simply means is that an insurance company or healthcare provider cannot give you any health-related information about your employee without your employee’s express authorization. 

illustration of a hand writing on a piece of paper with a red cross in the corner.
HIPAA does not stop you from asking an employee for a doctor’s note.

Common HIPAA Misconceptions

HIPAA can seem complicated. You have obligations when it comes to protecting your employees’ healthcare information, but, unless you are a healthcare company or a healthcare provider, you aren’t technically subject to HIPAA. The law really just regulates how employees’ protected healthcare information maintained by a healthcare plan can be shared with employers.

There are some myths surrounding how HIPAA affects you as an employer that we can debunk for you right now. HIPAA does NOT:

  • Stop you from asking for a doctor’s note for an absence
  • Affect your ability to ask for information related to workers compensation claims, wellness programs, or administering your healthcare plan 
  • Apply to employment records – but if health information is contained in them, you’ll have to get authorization from your employee’s physician and state that you will only use the records for the intended purposes.
  • Cover all employee benefit information. For example, employee life insurance, disability and workers’ compensation, and wellness programs are generally not covered under HIPAA.


While there are many ways that employers are not subject to HIPAA, there are still certain HIPAA rules that employers need to pay special attention to in order to remain in compliance with the law. Examples of these include: 

laptop with a lock on the screen and stars around the lock.

  • Electronic security rule – This rule requires that you take all reasonable measures to physically, technically, and administratively safeguard your employees’ personal information. Businesses are expected to take steps to ensure privacy, protect against threats, make sure employees are in compliance, and protect against unauthorized uses or disclosures of information.
  • Breach notification rule – If your insurance company or a healthcare provider experiences a data breach, everyone affected needs to be notified. The same goes if it happens to your business.
  • Privacy and personal health information rule (PHI) – According to the Department of Health and Human Services, “The HIPAA Privacy Rule protects most ‘individually identifiable health information’ held or transmitted by a covered entity or its business associate, in any form or medium, whether electronic, on paper, or oral.” Again, this really only applies to “covered entities” – or insurance companies and providers. But these covered entities need to make clear to you how PHI may be used or shared, and you need to remain in compliance with those privacy policies.

Common Violations of HIPAA

illustration of people with the heads as tv screens, one with an eye, one with an ear and one with a mouth
Unauthorized access or disclosure of an employee’s health information is a direct violation of HIPAA.

Despite some of the technicalities of what HIPAA covers, if you’re in possession of health information about your employees, it’s a good idea to stay on the safe side and use best practice to remain compliant with the law. This mainly means keeping your employees’ data safe and secure, and always going through the proper channels to obtain medical information. To give you some idea of what you should be looking out for, the most common HIPAA violations for employers are as follows:

  • Hacking/data breachesIf you don’t have the proper security measures in place, your employees’ information, including their health information, could be at risk of being hacked.
  • Theft/lossSimilarly, devices storing sensitive information could also be stolen.
  • Unauthorized access/disclosureEven if you obtain an employee’s information in the correct way, you still have to make sure that it is kept safe and not disclosed to anyone other than you or other authorized parties.
  • Improper disposalProtected information needs to be disposed of properly – information could be illegally obtained if you don’t take reasonable measures such as shredding documents.

Being an employer means taking care of your employees in lots of different ways. If you offer them healthcare as one way of taking care of them, that’s great – but protecting their personal and private information needs to be another way that you look after them. The rules surrounding HIPAA may seem complicated on first look, but the most important thing to remember is that you need to safeguard any sensitive information entrusted to you. If you have any questions about how HIPAA affects your healthcare plan – or if you have any other questions about offering healthcare to your employees – EZ is here to help. Our knowledgeable agents can do everything from answer questions to provide fast, accurate quotes to sign you up for a great plan – and we’ll do it all for free. To get started with us, enter your zip code in the bar above. Or to speak with an agent directly, call 888-350-1890.

QSERHA vs. Group Health, Whats Best For Your Company

Small business owners know the value of covering their employees. After all, everyone gets sick at some point. If you support your team’s wellness, you make a stronger team.

You might also see the value in comparing and then choosing the best option. Two of these are either QSERHA or group health insurance, but which one has the most value for your business? For the answer to that question, we’ll need to break each one down first.

It is important to sit down and compare all the options available to your business.


This choice was unavailable until now. The ACA has now widened the usefulness of HRAs. Previously, you couldn’t set up an account unless it was tied to a policy. For more info on this, read about 2020 HRA changes here. Thankfully, this puts a Qualified Small Employer Health Reimbursement Arrangement or QSERHA on the menu. 

So, what does it offer for your business?

This option skips the sometimes expensive group health insurance plans. While you’re missing out on the robust coverage insurers provide, the cost-saving benefits might be redistributed amongst your employees. 

With this HRA, you must follow the requirements: employees must already have minimum health insurance, and you have to set-up your HRA properly.  Afterward, you simply make contributions to the account, and later, the funds will be available to help pay for your employee’s medical expenses, tax-free.

Group Health

It comes down to which is better for your business. To help guide your decisions, see what your answers to these questions are:

  • Do my employees need healthcare assistance?
  • Is everyone on staff covered by an HRA already?
  • Does my budget include funds for a robust insurance option?

After answering these, you should have a better idea of which option to go for. If not, then consider the following:

QSERHA Group Health
Cost You can choose how much you contribute to the account. Premiums vary by provider but are generally more expensive.
Participation All employees must be offered coverage, but they do not have to accept. Generally, around 60% of your staff must be enrolled to qualify.
Coverage Can’t be in tandem with group health.

Employers can choose to reimburse medical expenses or premiums.

Primarily covers medical, dental, and vision
Eligibility  1-49 full-time employees 2-50 employees 

Note: some states requirements go up to 100


Hopefully, this chart helps guide your decision. No matter which you choose, remember that the health of your employees is important to your continued business. A healthy team is a happy team. However, if your budget allows, consider choosing the group health option. You’ll have an agent to help you with the tough questions plus the bonuses offered are well worth the price tag.


If you are looking to get more coverage for your company, EZ.Insure offers solutions. Your personalized agent will answer any questions you have, compare the plans available to you, and even sign you up when you are ready, free of charge. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing replies@ez.insure, or calling 888-998-2027. EZ.Insure makes the entire process simple, easy, and quick.


Your 2020 ACA Compliance Checklist

If you’re purchasing or renewing group health coverage, then you’ll need a comprehensive look at what changes are coming in 2020. The ACA is updated every year, so it can be difficult to stay on top of things. With our checklist, you’ll have a better understanding of what’s taking place so that you can make the best decisions for your company’s health coverage.

ACA checklist for business owners
As a business owner, you already have a lot on your plate, but don’t forget this checklist too!

Are you an Applicable Large Employer?

Several rules only apply to you if you’re considered an ALE (Applicable Large Employer). For example, the ACA states there are Employer Shared Responsibility rules that require ALEs to offer affordable coverage. However, if you don’t have 50+ employees in your workforce, this doesn’t apply to you.

This also goes for Employer Mandate Penalties. If you’re considered an ALE, you can incur penalties if you don’t follow certain ACA standards like:

  • Offering coverage to full-time employees plus their families (or dependants)
  • Offering coverage that is not affordable
  • Offering coverage that does not provide minimum value

As a note, the minimum value is the standard minimum coverage that you can get in employer-based plans. For example, the policy needs to pay at least 60% of the total cost of medical services for an average population.

Are You Informing Your Employees?

There are three major instances where your workforce needs to be notified. This means not only reaching out with the correct information, but also making supplemental information available, and being knowledgeable yourself so that you can help them make solid decisions.

The first is a written notice of ACA Exchange Requirements. This needs to be given to all new hires. Inside the notice, it should detail the ACA’s health insurance exchange and talk about how and why an individual can obtain coverage through an Exchange.

The second is a Summary of Benefits and Coverage or an SBC. Any plans you offer, including the providers that write these policies, need to be provided to each employee. Basically, this is to make sure everyone is up to date, and no one can say that they weren’t sure about different plan options or otherwise.

business owner talking with employees about ACA changes
Your employees are your team. Make sure you’re taking care of them with the best group policies.

The third is for ALEs only, and it’s providing 1094-C and 1095-C tax forms. These forms are specifically used to detail what benefits each employee receives from their employer’s health plan. 

For non-ALEs, the plans are 1094-B and 1095-B. These are only if you sponsor your workforce with a self-insured health plan. 

For both of these cases, you need to give the forms to your staff by January 31, 2020, and the forms need to be reported to the IRS. Once that’s done, you’re set!

Coverage Affordability

Your employees need to be able to afford their health plans. How can something qualify as unaffordable? Technically, the IRS has a guide to help make these decisions.

A plan is considered unaffordable if it’s offered at 9.78% less than their taxable household annual income. This means if they have a yearly income of $10,000, then the offered plans will be considered unaffordable if their costs amount to $9,780 or more for the year.

New Out-of-Pocket Maximum

With the ACA affecting health plans, there are changes to the dollar amount for certain factors in your health policies, specifically the out-of-pocket maximums.

The maximums for out-of-pocket expenditures are not to go above $8,150 for your employees as long as they cover the essential health benefits. This number is for individual coverage in your group health plan. For family coverage, the maximum is $16,300.

These changes can be confusing, and you don’t want anything to slip by when you decide on coverage. For any group health plan, the bottom line is to keep both your employees happy and your insurance premiums well within budget.

If you need help picking out the best policy, EZ.Insure offers you an expert guide. Your agent will answer any questions you have, compare the plans for you, and even sign you up, free of charge. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing replies@ez.insure, or calling 888-998-2027. EZ.Insure makes the entire process easy, simple, and quick.

What to Look for With 2020 Group Health Plans

Despite pushes for change in Congress, it looks like the ACA is still at the top of the list for people. With solid medical benefits and cheaper premiums, this controversial program will keep people covered, but with only the basic essentials. More and more, employer health seems to be the way to go if you want both comprehensive coverage while still maintaining a budget.

group health plan money with calculator
Calculating your savings is easier when you know what to look for.

The healthcare system seems to bring out a new update every month. It can get confusing to anyone that’s just started. Let’s take a look at what you can expect.

Besides the standard HRA improvements, there are more interesting changes to be aware of for the future. Here’s a couple we’ve found:

Accountable Care Organizations

These networks were created to foster cooperation in the healthcare system. Through building a “team” of sorts, hospitals, doctors, and specialists can provide a smooth transition through the system for the patients.

This is great news to watch for as an employer. Check with your group health plan to see if there’s a network near you to highlight for your employees. The easier you can make it for them to get well again, the better.

Virtual Care

Programs like Teledoc are growing in popularity. It’s no wonder considering their ease of use. Why go to a doctor’s office and deal with their wait times, prices, and discomfort when you can just pick up your phone for the same services? See if the plans you offer your employees include these services.

Of course, this won’t cover every case. However, rising at-home services could lead to improvements in our medical system. If you have something simple like the flu, and just need prescription medication to get well, then virtual care is a great fit. Think of how this can alleviate crowded doctor’s offices. In addition, the spread of germs would decrease as ill people can stay in the comfort of their own homes.

A 6% Premium Rise

Estimated premium increases are about 6% across the board. While some larger companies are implementing cost management adjustments (These tactics reduce their projected cost.), it still will only reduce the overall budget increase to 5%.

rising group health plan charges on tablet
Unfortunately, there’s no good news overall with health charges. Rates just seem to rise.

Statistically, the smaller to midsize businesses pay a bit more than their larger counterparts for the same benefits because they simply don’t have the clout to bargain prices down. These businesses do have the option of turning to consumer-directed health plans (CDHPs) to help out.

CDHPs are high-deductible health plans that are linked to either an HSA or an HRA. However, it’s projected that employers will reduce the number of employees covered by these CDHPs because employees have stated they’d rather have a choice for their benefits, meaning they’ll turn to other alternatives like a preferred provider organization (PPO).

With so many changes coming, it can be hard to see where your best choices lie in purchasing a new Group Health plan. While you can see the reasoning for it, the ultimate decision for your business needs to be a tailored fit. That way, you get the best coverage options for your workforce while still meeting your budget.

If you want to get the best coverage for your company, EZ.Insure offers solutions. Your personalized agent will answer any questions you have, compare the plans available to you, and even sign you up when you are ready, free of charge. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing replies@ez.insure, or calling 888-998-2027. EZ.Insure makes the entire process simple, easy, and quick.


When Can Your Employees Make Mid-Year Changes to their Group Health Policy?

When getting a Group health insurance policy companies understand that people are going to sign up for what they need now, and employees’ needs can often change. Maybe there is a new baby on the way so they want to increase their coverage, maybe they just realize that they are covering a lot of stuff that they don’t need. This leaves many companies and employees wondering when and how they can make additional changes to their policy. 

The Standards

The standard is that each year there is one open enrollment period, and this is when people in a group insurance policy can make adjustments to their plan.. However, there are special cases that qualify your staff for a Special Enrollment Period or SEP

automotive worker fixing a car as employee
Any industry employee can opt into a SEP. It just depends on why.

Group Health SEPs are available if your employee has a qualifying event. Here are the most common qualifying events:

  • Death
  • Marriage
  • Divorce
  • A new addition (child) to the family

The qualifying period starts when the event happens and only extends 60 days. Otherwise, it will not be considered eligible for a SEP. This means if someone gets married June 1st, they have 60 days from that date to change their coverage, after that they will have to wait until that year’s open enrollment period.

Other Qualifying Events

Another qualifying event is loss of health insurance. This could happen when someone is covered under their parent’s plan and ages out if they are covered under their spouses’ plan and they lose that plan, or several other reasons. If this happens your employee has 60 days from the date that their current insurance plan ends to get new coverage or change their coverage through you.

Employee writing on a white board with a blue pen
Qualifying events are special circumstances that allow entrance to a SEP. These can be as simple as moving.

A change in residence also gives entitles an employee to a SEP. These mid-year changes are:

  • Moving to a shelter
  • Transitioning as a seasonal worker
  • Going to a new location for school
  • Entering the US
  • Moving to a new home

In this instance, the employee must have health insurance before then to qualify. Also, a small move like an extended vacation or sabbatical does not allow for a SEP.

Additional circumstances that might qualify for a SEP:

  • Starting service in an organization like Service Year or Americorps
  • Leaving incarceration
  • Becoming a member of a First Nationer tribe
  • Becoming a US citizen

The last thing to keep in mind is if any of these qualifying factors do arise, employees will need to have the correct information to verify an SEP. They all require documentation, but those papers are easily found. For example, a birth certificate for a child is mandatory, this is a valid proof of documentation for the verification process.

business owner speaking with her employees about special enrollment periods
Talk to your employees about these periods. It can be a confusing time, and they will appreciate both your knowledge and guidance.

If you find yourself looking for a new, or first group health insurance plan, EZ.Insure offers solutions. Your agent will answer any questions you have, compare the plans available to you, and even sign you up when you are ready, free of charge. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing replies@ez.insure, or calling 888-998-2027. EZ.Insure makes the entire process simple, easy, and quick.




Group Insurance: Plan for Your Company’s Health

When and Why to Get a Group Insurance Plan

So, you’ve got a company, and you’re thriving. As a small employer that’s excellent news! But one thing that’s important for your employees (and thus, important to you) is insurance. Next to an employee’s income, health insurance is the second most important employee benefit. This includes health plans, medical insurance, etc, for both full and part-time workers.

business notebook with planning underlined
The planning stage comes first before you look into getting insurance.

One of the biggest factors in the job market out there is insurance, which is paramount to keeping your employees happy. Overall high morale reduces employee turnover, and a stable workforce is one of the greatest predictors of continued success. Guaranteed issue insurance can land your company in a “Best Places to Work” chart. Secure employees equal low turnover.

If you haven’t already, you need to look into a group insurance plan.

But what is it exactly?

What is Group Insurance?

This is a coverage type for a defined group of individuals. Usually, companies will offer health insurance as the primary offering and can supplement to include dental, vision, life or disability insurance.

Group insurance is a leg-up for both the companies and the beneficiaries. Because the companies get a large number of people to cover all at once, they can reduce their rates for said individuals, and the process will go smoothly as they want your business. Wholesale isn’t just for paper towels and bread.

So, in essence, it’s a bigger version of individual health insurance (a single policy) where the company is the individual, and all the employees are separate parts.

When to Acquire?

Technically, if you’re self-employed, you could apply for small group health insurance in some states. For the majority of business owners, you’ll probably be thinking bigger. You can look into this whenever you decide the time is right for your company. Many small businesses realize the benefits of having a group insurance plan, both for the business and for the employees, and opt to look into it sooner than later. .

doctor working with a business person
The peace of mind that comes from group health insurance is an attractive benefit.

Remember, the choice is yours to make this step for your business. One differentiation to note is employee number as it puts you in a separate category under the Affordable Care Act. However, this shouldn’t guide your decision.

There really aren’t “milestones” separating you from the uninsured line. When you’re ready to make the investment and are looking for the first time, there is no enrollment period you have to wait for. However, make sure that you start shopping at least 90 days prior to the date you want your insurance plan to be active.

If you feel like you’re wanting to purchase group insurance with a smaller business, one marker would be income. The average annual cost for an employee premium is around $5,000.  

So, if you can budget $5,000 per employee per year into your books, it may be well worth looking into.

Why Acquire?

There are many benefits to getting a group health insurance plan:

  • Your employees will likely be healthier given that they have access to healthcare.
  • These types of expenses for your business are tax deductible which means putting more money in your pocket.
  • The aforementioned lower turnover. Happy employees=a stable workplace

As you can see, the benefits will outweigh the costs. You’re going to want to keep your employees happy, and you’ll find support from the government and insurance agencies to smooth the process.

business man giving the thumbs up
You can do this! You have all the help and support you need.

Acquiring new insurance and seeking a personalized plan can be difficult and time-consuming. An agent will do the smooth the process, allowing you more time to focus on your business.

EZ.Insure offers you this solution. Your agent will answer any questions you have, compare the plans for you, and even sign you up, free of charge. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing replies@ez.insure or calling 888-998-2027. EZ.Insure makes the entire process easy, and quick.