Our uses and disclosures of protected health information
We may use and disclose your PHI for the following purposes without your authorization:
∙ To you and your personal representative: We may disclose your PHI to you or to your personal representative (someone who has the legal right to act for you).
∙ For treatment: We may use and disclose your PHI to health care providers (examples include: doctors, dentists, pharmacies, hospitals and other caregivers) who request it in connection with your treatment. For example, we may disclose your PHI to health care providers in connection with disease and case management programs.
∙ For Payment: We may use and disclose your PHI for our payment-related activities and those of health care providers and other health plans, including:
• Obtaining premium payments and determining eligibility for benefits
• Paying claims for health care services that are covered by your health plan
• Responding to inquiries, appeals and grievances
• Coordinating benefits with other insurance you may have
∙ For health care operations: We may use and disclose your PHI for our health care operations, including for example:
• Conducting quality assessment and improvement activities, including peer review.
• Performing outcome assessments and health claims analyses
• Preventing, detecting and investigating fraud and abuse
• Underwriting, rating and reinsurance activities (although we are prohibited from using or disclosing any genetic information for
• Coordinating case and disease management activities
• Communicating with you about treatment alternatives or other health-related benefits and services
• Performing business management and other general administrative activities, including systems management and customer service
We may also disclose your PHI to other providers and health plans who have a relationship with you for certain health care operations. For example, we may disclose your PHI for their quality assessment and improvement activities or for health care fraud and abuse detection.
∙ To others involved in your care: We may, under certain circumstances, disclose to a member of your family, a relative, a close friend or any other person you identify, the PHI directly relevant to that person’s involvement in your health care or payment for health care. For example, we may discuss a claim decision with you in the presence of a friend or relative, unless you object.
∙ When required by law: We will use and disclose your PHI if we are required to do so by law. For example, we will use and disclose your PHI in responding to court and administrative orders and subpoenas, and to comply with workers’ compensation laws. We will disclose your PHI when required by the Secretary of the Department of Health and Human Services and state regulatory authorities.
∙ For matters in the public interest: We may use or disclose your PHI without your written permission for matters in the public interest, including for example:
• Public health and safety activities, including disease and vital statistic reporting, child abuse reporting, and Food and Drug
• Reporting adult abuse, neglect or domestic violence
• Reporting to organ procurement and tissue donation organizations
• Averting a serious threat to the health or safety of others
∙ For research: We may use and disclose your PHI to perform select research activities, provided that certain established measures to protect your privacy are in place.
∙ To communicate with you about health-related products and services: We may use your PHI to communicate with you about health-related products and services that we provide or are included in your benefits plan. We may use your PHI to communicate with you about treatment alternatives that may be of interest to you. These communications may include information about the health care providers in our networks, about replacement of or enhancements to your health plan, and about health-related products or services that are available only to our enrollees and add value to your benefits plan.
∙ To our business associates: From time to time, we engage third parties to provide various services for us. Whenever an arrangement with such a third party involves the use or disclosure of your PHI, we will have a written contract with that third party designed to protect the privacy of your PHI. For example, we may share your information with business associates who process claims or conduct disease management programs on our behalf. You may give us written authorization to use your PHI or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosure permitted by your authorization while it was in effect. Some uses and disclosures of your PHI require a signed authorization:
∙ For marketing communications: Uses and disclosures of your PHI for marketing communications will not be made without a signed authorization except where permitted bylaw.
∙ Sale of PHI: We will not sell your PHI.
∙ Psychotherapy notes: To the extent (if any) that we maintain or receive psychotherapy notes about you, disclosure of these notes will not be made without a signed authorization except where permitted by law.
Any other use or disclosure of your protected health information, except as described in this Notice of Privacy Practices, will not be made without your signed authorization.