According to Health Insurance Portability and Accountability Act (HIPAA), when can a group health policy...

The correct answer is Participation or contribution rules have been violated . Under HIPAA’s guaranteed renewability standards for group health coverage, an insurer generally must renew a group health policy. However, renewal may be denied in certain limited circumstances, one of which is when the plan sponsor or group fails to comply with applicable participation requirements or employer contribution rules . Federal materials describing HIPAA portability and renewability protections specifically list violation of participation or contribution rules as a valid basis for nonrenewal.

This means an insurer cannot refuse renewal simply because the group had too many claims or because the group’s size changed. High claims experience alone is not one of the standard HIPAA nonrenewal reasons. Likewise, merely changing participation or contribution rules is not the same as violating them. The key issue is noncompliance with the rules that apply to the coverage.

So, for exam purposes, when asked when HIPAA allows denial of renewal of a group health policy, the recognized answer is C. Participation or contribution rules have been violated .