If your SaaS handles healthcare data, HIPAA compliance isn't optional for your email tool. Any platform that processes, stores, or transmits Protected Health Information (PHI) on your behalf must sign a Business Associate Agreement (BAA) and meet HIPAA's security and privacy requirements.

The problem: most email marketing tools don't support HIPAA. They weren't designed for healthcare data. Sending an email with patient information through a non-compliant platform is a HIPAA violation, regardless of how the patient signed up.

Here's which email platforms actually support HIPAA compliance and what that means practically.

What HIPAA Compliance Requires From Your Email Tool

Business Associate Agreement (BAA): A legal contract between you (the covered entity or business associate) and the email platform (the subcontractor). This is non-negotiable.
PHI safeguards: Technical, physical, and administrative safeguards for any PHI the platform processes
Encryption: Data encrypted in transit (TLS) and at rest
Access controls: Role-based access, authentication, and audit logging
Breach notification: The platform must notify you within 60 days of discovering a breach
Minimum necessary: The platform should only access the minimum PHI necessary for its function

Important: HIPAA compliance is about the overall system, not just one tool. A HIPAA-compliant email platform doesn't make your entire email program compliant. You also need compliant processes, training, and documentation.

The 6 Best Options

1. Sequenzy

Best for: Health tech SaaS companies needing compliant email automation

Sequenzy provides HIPAA-compliant email infrastructure for health tech companies. The platform signs BAAs and implements the technical safeguards required for handling subscriber data in healthcare contexts: TLS encryption in transit, encryption at rest, role-based access controls, and audit logging.

What sets Sequenzy apart from pure infrastructure options is that you get full marketing automation alongside compliance. Build behavioral email sequences, automate lifecycle communications, and manage subscribers without needing to piece together multiple compliant tools. For health tech SaaS companies that need both compliance and marketing capabilities, Sequenzy eliminates the gap between infrastructure and features.

BAA: Available on all plans Encryption: TLS in transit, AES-256 at rest Audit logging: Full activity logs for compliance audits Pricing: From $29/month Pros: Full marketing platform with BAA, automation included, SaaS-focused features Cons: Newer platform, smaller compliance track record than AWS

2. Amazon SES

Best for: HIPAA-eligible infrastructure for technical teams

Amazon SES is HIPAA-eligible, meaning AWS will sign a BAA that covers SES. AWS has extensive HIPAA compliance documentation and a well-established BAA process. For technical teams building healthcare applications on AWS, SES is the natural choice for email.

The trade-off: SES is pure infrastructure. You get sending APIs, but no marketing features, templates, or automations. Your application handles everything else. For healthcare companies that need email sending infrastructure within a HIPAA-compliant AWS environment, this is the most straightforward path.

BAA: Available (AWS BAA covers SES) Encryption: TLS in transit, encryption at rest (AWS KMS) Audit logging: Via CloudTrail Pricing: $0.10 per 1,000 emails Pros: AWS BAA, well-documented compliance, scales, part of broader HIPAA AWS infrastructure Cons: No marketing features, pure infrastructure, requires development work

3. Mailgun

Best for: Email infrastructure with BAA for healthcare applications

Mailgun offers HIPAA-compliant email infrastructure with BAA availability on enterprise plans. The platform provides email sending, receiving, and routing with the security controls HIPAA requires. Mailgun's parent company (Sinch) has experience with healthcare communications.

Like SES, Mailgun is primarily email infrastructure rather than a marketing platform. You get APIs for sending, inbound processing, and email validation. Marketing automation and campaign management would need to be built on top or handled by a separate compliant tool.

BAA: Available on enterprise plans Encryption: TLS in transit, encryption at rest Audit logging: Via API logs and webhooks Pricing: Custom for HIPAA (enterprise plan) Pros: BAA available, email infrastructure, inbound processing, email validation Cons: Enterprise pricing for HIPAA, no marketing features, requires setup

4. SendGrid

Best for: HIPAA-eligible email with both transactional and marketing capabilities

SendGrid (owned by Twilio) is HIPAA-eligible, and Twilio will sign a BAA that covers SendGrid. This gives you both transactional email and marketing campaigns within a HIPAA-compliant framework. SendGrid is one of the few platforms that offers marketing email features with BAA coverage.

For healthcare companies that need to send both operational emails (appointment confirmations, test results, billing) and marketing emails (health tips, wellness campaigns, service announcements), SendGrid can handle both under one BAA.

BAA: Available (Twilio BAA covers SendGrid) Encryption: TLS in transit, encryption at rest Audit logging: Activity feed, event webhooks Pricing: Custom for HIPAA (Pro plan and above) Pros: BAA available, transactional + marketing, broad features, reliable infrastructure Cons: HIPAA features on higher-priced plans, marketing features less polished

5. Postmark

Best for: HIPAA-compliant transactional email with best deliverability

Postmark offers a BAA for customers who need HIPAA compliance. Given Postmark's focus on transactional email (appointment confirmations, prescription notifications, test result alerts), the HIPAA compatibility is a natural fit. These are exactly the kinds of emails healthcare applications need to send reliably.

Postmark's deliverability advantage matters for healthcare. An appointment reminder that lands in spam is a missed appointment. A test result notification that doesn't arrive causes patient anxiety. Postmark's consistent inbox placement reduces these risks.

BAA: Available Encryption: TLS in transit, encryption at rest Audit logging: Activity logs, webhooks Pricing: Standard pricing with BAA Pros: BAA available, best deliverability, transactional email focus, reliable Cons: Limited marketing features, primarily transactional

6. Paubox

Best for: Healthcare-specific email encryption and compliance

Paubox is built specifically for healthcare email. The platform provides HIPAA-compliant email encryption that works seamlessly with standard email clients (recipients don't need to use a portal or special software to read encrypted emails). Paubox signs a BAA and includes features specifically designed for healthcare compliance.

Unlike the other options on this list, Paubox is not a marketing email platform. It's an email encryption and compliance layer that ensures all email sent by your organization meets HIPAA requirements. For healthcare organizations whose primary concern is securing email communication (not marketing), Paubox is purpose-built.

BAA: Included (healthcare-first platform) Encryption: Zero-step encryption (transparent to recipients), TLS with fallback Audit logging: Comprehensive audit trails Pricing: From $29/month per user Pros: Healthcare-specific, seamless encryption, no portal for recipients, BAA included Cons: Not a marketing platform, per-user pricing, limited automation

HIPAA Email Best Practices

Minimize PHI in Email

The safest approach is to avoid including PHI in email content altogether:

Instead of: "Your blood test results show elevated glucose levels"
Send: "Your test results are available. Log in to view them: [link]"

This approach means the email itself doesn't contain PHI, reducing compliance risk. The PHI stays in your HIPAA-compliant application.

Encryption Is Non-Negotiable

All email containing or potentially containing PHI must be encrypted in transit (TLS) and at rest. Most modern email platforms support TLS by default, but verify that your platform enforces it (doesn't fall back to unencrypted if TLS negotiation fails).

Separate Marketing and Clinical Email

Use different sending infrastructure for:

Clinical/operational: Appointment reminders, test results, prescriptions (PHI involved)
Marketing: Wellness tips, service promotions, newsletters (no PHI)

Marketing emails typically don't contain PHI and can use standard email platforms. Clinical emails require HIPAA-compliant infrastructure.

Document Everything

HIPAA compliance requires documentation of your email practices:

What PHI is transmitted via email
What safeguards are in place
Which platforms have signed BAAs
How you handle breaches
Staff training records

FAQ

Can I use Mailchimp for HIPAA-compliant email? Mailchimp does not sign BAAs and is not HIPAA-compliant. Using Mailchimp to send emails containing PHI is a HIPAA violation. You can use Mailchimp for marketing emails that contain zero PHI (wellness tips, general announcements).

Is email inherently non-compliant with HIPAA? No, but standard email (Gmail, Outlook without encryption) is not HIPAA-compliant for PHI. Email sent through HIPAA-eligible platforms with proper encryption and BAAs can be compliant.

What's the penalty for sending PHI through a non-compliant email tool? HIPAA violations range from $100 to $50,000 per violation, up to $1.5 million per year for violations of the same provision. Willful neglect with no correction can result in criminal penalties.

Do patient appointment reminders require HIPAA compliance? Yes. An appointment reminder reveals that the patient has an appointment with a healthcare provider, which is PHI. The email platform sending the reminder needs to be HIPAA-compliant with a signed BAA.

Can I use a marketing email tool for non-PHI healthcare marketing? Yes. General health tips, wellness content, service announcements, and newsletters that contain zero PHI can be sent through standard email platforms without HIPAA requirements. The key is ensuring no PHI is included in the content, subject line, or recipient targeting criteria.