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How We May Use and Disclose Your Protected Health Information
The following is a description of how we are most likely to use and/or disclose your protected health information. Where state law provides additional restrictions on how we can use and disclose information, we will follow applicable state laws.
Payment
We may use or disclose your protected health information to obtain premiums, to determine cost share, or otherwise fulfill our responsibilities established under your member contract. For example, we may disclose your protected health information when a provider requests information regarding your eligibility for coverage under our health plan.
Treatment
While we do not provide medical treatment, we may use your protected health information to assist health care providers in coordinating or arranging medical treatment or services for you.
Health Care Operations
We may use or disclose your protected health information to support our business functions. For example, we may use your information to conduct audits or medical review of claims activity.
Business Associates
We contract with individuals and entities (known as 'business associates") to perform various functions on our behalf or to provide certain types of services. Some of the functions they provide are administering claims, member service support, utilization management, subrogation, and pharmacy benefit management. To perform these functions or to provide the services, business associates may receive, create, maintain, use, or disclose protected health information, but only after we require the business associates to agree in writing to contract terms designed to appropriately safeguard your information.
Health Oversight Activities.
We may disclose your protected health information to a health oversight agency for activities authorized by law, such as audits; investigations; inspections; and licensure or disciplinary actions.
Required by Law or Legal Proceeding
We may use or disclose your protected health information to the extent that federal, state, or local law requires the use or disclosure. For example, we make disclosures when the law requires that we report information to a government agency or law enforcement personnel. We may also disclose your protected health information in response to a subpoena, regulatory inquiry or audit.
Health Promotion and Disease Prevention
We may use your protected health information to tell you about disease prevention and health care programs. For example, we may send you information about diabetes and asthma programs.
Plan Sponsor
If you are covered under a group health plan or HMO, we may disclose your protected health information to the sponsor of your health plan.
Workers' Compensation.
We may disclose your protected health information to comply with workers' compensation laws and other similar programs that provide benefits for work-related injuries or illnesses.
Others Involved in Your Health Care
Unless you object, we may disclose your protected health information to a friend or family member that you have identified as being involved in your health care. If you are not present or able to agree to these disclosures of your protected health information, then we may, using our professional judgment, determine whether the disclosure is in your best interest.
• We Have a Legal Duty to Safeguard Your Protected Health Information
• Other Uses and
Discloses of Your Protected Health Information
• Your Rights
Regarding Your Protected Health Information
• How to Complain
About Privacy Practices |
