Notice of Privacy
Regarding Personal Health Information
notice describes how medical information about you may be used and disclosed
and how you can get access to this information. Please review it carefully.
This notice provides you with information about the way in which We protect
Personal Health Information (“PHI”) that We have about you.
PHI includes individually identifiable information which relates to your
past, present or future health, treatment or payment for health care services.
This notice also explains your rights with respect to PHI.
The Health Insurance Portability and Accountability Act (“HIPAA”)
requires Us to: Keep Personal Health Information PHI about you private;
provide you this notice of our legal duties and privacy notices with respect
to your PHI; and follow the terms of the notice that are currently in
Use and Disclosure of PHI
We obtain PHI in the course of providing and/or administering health insurance
benefits for you. In administering your benefits, We may use and/or disclose
Personal Health Information PHI about you and your dependents. The following
are some examples, however, not every use or disclosure in a category
will be listed:
- For Health Care Payment Purposes: For example, We
may use and disclose Personal Health Information PHI to administer and
process payment of benefits under your insurance coverage, determine
eligibility for coverage, claims or billing information, conduct utilization
reviews, or to another entity or health care provider for its payment
- For Health Care Operations Purposes: For example,
We may use and disclose Personal Health Information PHI for underwriting
and rating of the plan, audits of your claims, quality of care reviews,
investigation of fraud, performance measurements, care coordination,
investigate and respond to complaints or appeals, provider treatment,
review and provision of services.
- For Treatment Purposes: For example, We
may use and disclose information PHI to health care providers to assist
in their treatment of you. We do not provide health care treatment to
- For Health Services: For example, We may
use your medical information to contact you to give you information
about treatment alternatives or other health related benefits and services
that may be of interest to you as part of large case management or other
insurance related services.
- For Data Aggregation Purposes: For example,
We may combine PHI about many insured participant to make plan benefit
decisions, and the appropriate premium rate to charge.
- To You About Dependents: For example, We
may use and disclose PHI about your dependents for any purpose identified
herein. We may provide an explanation of benefits for you or any of
your dependents to you.
- To Business Associates: For example, We
may disclose PHI to administrators who are contracted with Us who may
use the PHI to administer health insurance benefits on our behalf and
such administrators may further disclose PHI to their contractors or
vendors as necessary for the administration of health insurance benefits.
If your state has adopted a more stringent standard regarding any of
the above uses or disclosures of your PHI, those standards will be applied.
Additional Uses or Disclosures. We may also disclose
PHI about you for the following purposes:
- To comply with legal proceedings, such as a court or administrative
order, subpoena or discovery requests.
- To law enforcement officials for limited law enforcement purposes.
- To a family member, friend or other person, for the purpose of helping
you with your health care or with payment for your health care, if you
are in a situation such as a medical emergency and you cannot give your
agreement to the Plan to do this.
- To your personal representatives appointed by you or designated by
- For research purposes in limited circumstances.
- To a coroner, medical examiner, or funeral director about a deceased
- To an organ procurement organization in limited circumstances.
- To avert a serious threat to your health or safety or the health
or safety of others.
- To a governmental agency authorized to oversee the health care system
or government programs.
- To the Department of Health and Human Services for the investigation
of compliance with HIPAA or to fulfill another lawful request.
- To federal officials for lawful intelligence, counterintelligence,
national security purposes and to protect the president.
- To public health authorities for public health purposes.
- To appropriate military authorities, if you are a member
of the armed forces.
- In accordance with a valid authorization signed by you.