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2015 Individual & Family Plans
We are allowed to use and disclose information that falls within one of the following categories:
1. Payment.
We may use and disclose your health information to make and collect payment for treatment and services
you receive, such as: determining your eligibility for plan benefits, obtaining premiums, determining your health plan’s
responsibility for benefits, and collecting payment for your health services.
2. Health care operations.
We may use and disclose your health information to support our business activities and
improve our coverage and services. Health care operations include such activities as:
• Underwriting, premium rating, and other functions related to plan coverage. However, we are not allowed to use
genetic information to decide whether we will give you coverage or the price of that coverage.
• Quality assessment and improvement activities.
• Activities designed to improve health and reduce health care cost.
• Case management and care coordination.
3. Treatment.
We may disclose your health information to a physician or other health care provider that is treating you. We
may contact you with information on treatment alternatives and other related functions that may be of interest to you.
4. Distributing health-related benefits and services.
We may use and disclose your health information to
provide information on health-related benefits and services that may be of interest to you.
5. Disclosure to plan sponsors.
If applicable, we may disclose your health information to the sponsor of your group
health plan for purposes of administering benefits under the plan. If you have a group health plan, your employer is the
plan sponsor.
6. Public safety.
We can share health information about you for certain situations such as: preventing disease; helping
with product recalls; reporting adverse reactions to medications; reporting suspected abuse, neglect, or domestic
violence; and preventing or reducing a serious and imminent threat to the health or safety of a particular person or
the public.
7. Research.
Under certain circumstances, and only after a special approval process, we may use and disclose your
health information to help conduct research.
8. Required by law.
We will share information about you if laws require it, including with the Department of Health and
Human Services if it wants to see that we are complying with federal privacy law.
9. Workers’ Compensation, law enforcement, and other government requests.
We can use and
share health information about you: for workers’ compensation claims; for law enforcement purposes or with a law
enforcement official; with health oversight agencies for activities authorized by law; and for special government
functions such as military, national security, and presidential protective services.
10. Legal actions.
We may disclose your health information in the course of any administrative or judicial proceeding.