Group Health Plan Disclosures to Plan Sponsors

A group health plan and the health insurer or HMO offered by the plan may disclose the following protected health information to the "plan sponsor"-the employer, union, or other employee organization that sponsors and maintains the group health plan:

• Enrollment or disenrollment information with respect to the group health plan or a health insurer or HMO offered by the plan.
• If requested by the plan sponsor, summary health information for the plan sponsor to use to obtain premium bids for providing health insurance coverage through the group health plan, or to modify, amend, or terminate the group health plan. "Summary health information" is information:
  • that summarizes claims history, claims expenses, or types of claims experience of the individuals for whom the plan sponsor has provided health benefits through the group health plan, and
  • that is stripped of all individual identifiers other than five digit zip code (though it need not qualify as de-identified protected health information).
• Protected health information of the group health plan’s enrollees for the plan sponsor to perform plan administration functions. The plan must receive certification from the plan sponsor that the group health plan document has been amended to impose restrictions on the plan sponsor’s use and disclosure of the protected health information. These restrictions must include the representation that the plan sponsor will not use or disclose the protected health information for any employment-related action or decision or in connection with any other benefit plan.