Health Oversight Activities: The Plan may share PHI, as provided by law, with Health Oversight Agencies, regulatory authorities or their appointed designees and reporting agencies. These agencies include, but are not limited to, the Centers for Medicare and Medicaid Services.
Business Associates: The Plan may disclose PHI to entities that perform a wide variety of services on our behalf. For example, we work with auditors, attorneys, actuaries, consultants, and other health care plans who act as third-party administrators for the Plan.
To Individuals Involved in Your Care or Payment for Your Care: We generally will not disclose PHI to your family members, close friends or others without your written authorization. However, under certain circumstances, the Plan may disclose PHI to such persons. For example, if you appear at the Plan office with your spouse and ask for PHI, we may ask you if we can provide you with your PHI in front of your spouse or even infer that it is permissible because you have brought your spouse with you. However, this verbal or implied authorization only applies to the particular disclosure and future disclosures of PHI to family members will require a new authorization, either written or verbal, depending on the circumstances. We may also disclose PHI for certain limited purposes to your family members, close friends or others in cases of a medical emergency where you are unable to provide authorization.
Disaster Relief: The Plan may use or disclose your name, location and general condition or death to a public or private organization authorized by law or by its charter to assist in disaster relief efforts, such as the American Red Cross.
Plan Sponsor: The Plan may disclose eligibility, enrollment, and limited disenrollment information to our plan sponsor in order to permit them to perform their plan administration functions on behalf of the Plan. We may provide our plan sponsor with complete information relating to voluntary disenrollment information. We will limit the information we provide to the plan sponsor relating to involuntary disenrollment (termination of benefits) to a statement that the particular Member’s benefits have been terminated and, if applicable, the fact that a Health Oversight Agency has been notified.
We may also disclose summary information about you and the participants enrolled in the Plan to our plan sponsor for them to use to obtain premium bids for the health insurance coverage we offer and/or to decide whether to modify, amend or terminate any of the benefits we currently offer through the Plan. The information we may disclose will simply summarize the claims history, claims expenses, or types of claims experienced by the participants in the Plan. The summary information will be stripped of demographic information (e.g., name and address) but it is possible that the plan sponsor may be able to identify information about you or other participants contained in the summary information. In order to obtain any of the above information, the plan sponsor will be required to provide assurances to us that the confidentiality of the information will be protected and that the information will not be used in any employment-related decisions. No other information will be shared with the plan sponsor without your Authorization, executed according to the Plan’s Authorization policy.
Public Health and Communicable Disease Reporting: The Plan may disclose your PHI to a public health authority who is permitted by law to collect or receive the information. Our reporting may be made in order to prevent or control disease, injury or disability, report child abuse or neglect, notify a person who may have been exposed to a disease or may be at risk for contracting a disease or condition or notifying the appropriate government authority if we believe a Member has been the victim of abuse, neglect or domestic violence, to name a few.
Research, Death, Organ Donation: The Plan may use or disclose PHI for research purposes, in limited circumstances and with certain safeguards. We may also disclose the PHI of a deceased person to a coroner, medical examiner, funeral director, or organ procurement organization for certain purposes.
Required by Law: For example, the Plan must disclose your PHI to the U.S. Department of Health and Human Services if it asks to see it for purposes of determining whether we are in compliance with federal privacy laws. We may also disclose your PHI when authorized by Workers’ Compensation or similar laws.
To Law Enforcement and for Public Safety: Under certain circumstances, we may disclose your PHI for law enforcement purposes. Examples include: responding to court orders, warrants, or grand jury subpoenas; providing PHI in response to requests by law enforcement officials for identification and/or location of individuals; responding to inquiries by law enforcement relating to victims of crime; providing information to law enforcement with respect to crimes occurring on the Plan’s premises. In addition, under some circumstances, we may disclose your PHI in order to prevent or lessen a serious and imminent threat to the health or safety of a person or the public (including providing information to law enforcement authorities to apprehend a suspect or fugitive or advising an individual about threats made against them). Finally, we may disclose your PHI if you are an inmate or other person in lawful custody and we are requested to do so by an appropriate law enforcement official or correctional institution.
Military and National Security: Under certain circumstances, the Plan may disclose the PHI of armed forces personnel to military authorities. We may also disclose PHI to authorized federal officials for lawful intelligence, counterintelligence, and other national security activities.
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