Health plans are considered covered entities under HIPAA because they handle individuals' protected health information (PHI) as an integral part of their operations. This includes personal and sensitive data related to an individual's health and healthcare services. Health plans must comply with HIPAA's marketing guidelines when offering services to their customers.
HIPAA Privacy Rule and marketing
The HIPAA Privacy Rule addresses marketing in healthcare, focusing on communications by covered entities that promote products or services. Marketing under HIPAA involves any outreach that encourages individuals to buy or use these offerings. It places a significant necessity on safeguarding patient privacy while allowing organizations to communicate meaningfully.
The rule aims to ensure that marketing practices in the healthcare industry are transparent, respectful of individuals' privacy rights, and conducted with proper consent when required. It sets specific standards and guidelines for these marketing activities.
See also: How to align email marketing with the HIPAA Security Rule
Can health plans offer additional services to customers?
In short, yes. Value-added items or services (VAIS) in health plan marketing refer to additional benefits or offerings that a healthcare organization may provide to its members. These VAIS are typically related to health and well-being and are designed to enhance the value of the health plan membership. Examples of VAIS include discounts on healthcare products or services like eyeglasses, prescription drug cards, or health/fitness club memberships.
VAIS must meet specific criteria to qualify for inclusion in health plan marketing without requiring additional authorizations. They need to be health-related and genuinely add value to the plan membership. This approach allows healthcare organizations to offer extra benefits to their members while ensuring that these offerings align with the overall goal of promoting health and well-being.
Exclusions for marketing for health plans
Communications about a health plan's plan of benefits are generally excluded from the definition of marketing. A few examples of these include:
- Communications about health plan benefits: Marketing exclusions allow health plans to communicate information about their plan benefits without it being considered marketing.
- Descriptions of healthcare provider networks: Health plans can describe the entities participating in healthcare provider networks without it being classified as marketing.
- Notices about changes in healthcare coverage: Communications regarding changes in deductibles, co-pays, prescription drug coverage, and other types of coverage are typically excluded from marketing definitions.
- Special healthcare policies: Special healthcare policies such as guaranteed issue products and conversion policies are not generally categorized as marketing.
Authorization requirements for health plan marketing
Authorization requirements for health plan marketing come into play when healthcare organizations intend to send marketing materials that don't meet the specific criteria for exclusions under the HIPAA Privacy Rule. In such cases, healthcare entities need to obtain written authorizations from individuals before sending marketing communications. These authorizations serve as a way to ensure that patients have consented to receive promotional materials. It helps balance allowing healthcare organizations to inform their members about healthcare-related products or services and respecting individuals' rights to privacy and choice.
How HIPAA distinguishes between marketing and treatment emails
Marketing emails are promotional and typically aim to generate sales or engagement. Marketing emails require prior authorization from patients before being sent, and they must adhere to both HIPAA regulations and the CAN-SPAM Act. Examples of marketing emails include announcements of healthcare-related products or services that are not directly related to the patient's immediate treatment. A beneficial tool for all healthcare organizations, including health plans, is HIPAA compliant marketing services to ensure maintained compliance.
Unlike marketing emails, treatment emails do not require prior authorization from patients. However, healthcare providers must implement reasonable safeguards to protect the privacy and security of patients' PHI. Treatment emails are exempt from marketing regulations and are necessary to facilitate effective patient care.
See also: Why Paubox Marketing for healthcare email marketing?
Kirsten Peremore
