Under HIPAA, when can a group health policy renewal be denied?

• A. Nonpayment of premium
• B. Change in employer
• C. Participation or contribution rules violated
• D. Late claim filing

Answer: (C)

HIPAA allows renewal of a group health plan only if the group continues to meet the plan’s eligibility rules, including participation and employer-contribution requirements. If those participation or contribution rules are violated, the insurer can refuse to renew the group contract. This keeps the renewal process tied to the group’s ongoing compliance with the agreed-upon terms and prevents adverse selection.

Issues like not paying premiums, a change in the employer, or late claim filing are not grounds for renewing denial in this context. Nonpayment typically affects the current coverage (potential lapse or cancellation), a change in employer usually results in a new contract rather than a renewal denial, and late claim filing deals with claims processing rather than the renewal decision.