Federal risk plans notice of privacy practices
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Notice of Privacy Practices
Para recibir esta notificación en español por favor llamar al número gratuito de Member Services (Servicios a Miembros) que figura en su tarjeta de identificación.
- You can get this Notice in Spanish by calling the number on your member ID card Account & Service Control
To receive this Notice in Spanish, please call the toll-free number on your member ID card.
- You can get this Notice in Spanish by calling the number on your member ID card Account & Service Control
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
- The Notice covers Aetna Life Insurance Company and its affiliated covered entity Sharing & Disclosure
PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy Practices (Notice) describes the privacy practices of Aetna Life Insurance Company. For purposes of this Notice, “Aetna” and the pronouns “we,” “us” and “our” refer to all of the HMO and licensed insurer subsidiaries of Aetna Inc. These entities have been designated as a single affiliated covered entity for federal privacy purposes. The members of the Aetna ACE can share Protected Health Information (PHI) with each other. We do this for the treatment, payment and health care operations of the Aetna ACE and as allowed by HIPAA and this Notice. For a full list of the members of the Aetna ACE, contact the Aetna Privacy Office at PrivacyAetna@aetna.com.
- The Notice covers Aetna Life Insurance Company and its affiliated covered entity Sharing & Disclosure
This Notice applies to insured plans
This Notice of Privacy Practices is for Aetna insured health benefit plans. It does not apply to any plans that are self-funded by an employer. If you have coverage where you work, ask your employer if your plan is insured or self-funded. If it’s self-funded, ask for a copy of your employer’s Privacy Notice.
- The Notice applies to insured plans, not employer self-funded plans Legal Rights & Agreement Rules
Effective date: This Notice took effect on October 1, 2025.
- The Notice took effect on October 1, 2025 Legal Rights & Agreement Rules
In this Notice, we describe:
- Information we collect about you
- How we use and share your information
- Times when we must share your information
- When we may share your information with those involved in your care
- When we need your okay to use or share your information
- Your rights under the law
- How we keep your information safe
- How we comply with the law
- When this Notice may change
GR-67806-17 (2-26) Federal Risk Plans
- The Notice took effect on October 1, 2025 Legal Rights & Agreement Rules
Information we collect about you
We get information about you from many sources, including from you. But we also can get it from your employer or benefits plan sponsor (if applicable), other insurers, HMOs or third-party administrators, and health care providers such as doctors.
- Aetna gets your information from you and from employers, insurers, administrators and providers Data Access & Collection
This is called Protected Health Information (PHI). It includes personal information that may identify you that is not public information. And it includes information about your health, medical conditions and prescriptions.
- PHI includes identifying non-public information and health, coverage and test details Data Access & Collection
It may include:
- Demographic data (like your name or address)
- PHI includes identifying non-public information and health, coverage and test details Data Access & Collection
- Health details (like a medical history)
- PHI includes identifying non-public information and health, coverage and test details Data Access & Collection
- Test results (like a lab test)
- PHI includes identifying non-public information and health, coverage and test details Data Access & Collection
- Insurance information (like your member ID)
- PHI includes identifying non-public information and health, coverage and test details Data Access & Collection
- Other information used to identify you or that’s linked to your health care or health care coverage
- PHI includes identifying non-public information and health, coverage and test details Data Access & Collection
How we use and share your information
In providing your health benefits, we may use and share PHI about you in varied ways. For instance:
Health care operations: We may use and share your PHI for our health care operations.
- Aetna may use and share PHI for its health care operations Use & Processing
Those are actions we need to do to run our health business, including:
- Aetna may use and share PHI for its health care operations Use & Processing
- Quality assessment and improvement
- Aetna may use and share PHI for its health care operations Use & Processing
- Licensing
- Aetna may use and share PHI for its health care operations Use & Processing
- Accreditation by independent organizations
- Aetna may use and share PHI for its health care operations Use & Processing
- Performance measurement and outcomes assessment
- Aetna may use and share PHI for its health care operations Use & Processing
- Health services research
- Aetna may use and share PHI for its health care operations Use & Processing
- Preventive health, disease and case management, and care coordination For example, we may use your PHI to offer programs for certain conditions, such as diabetes, asthma, or heart failure. We may also use it for other operations requiring use and disclosure, such as:
- Administering reinsurance and stop loss
- Underwriting and rating
- Investigating fraud
- Running pharmaceutical programs and payments
- Moving policies or contracts from and to other health plans
- Facilitating a sale, transfer, merger or consolidation of all or part of Aetna with another entity (including related due diligence)
- Performing other general administrative activities (including data and information systems management and customer service)
We may disclose your protected health information to the U.S. Office of Personnel Management (OPM) in connection with payment or healthcare operations when required by
- Aetna may disclose PHI to the U.S. Office of Personnel Management when required by law Sharing & Disclosure
law. We may also disclose your PHI to OPM for its Federal Employees Health Benefits (FEHB) Program and Postal Service Health Benefits (PSHB) Program Claims Data Warehouse when required by law.
- Aetna may disclose PHI to the U.S. Office of Personnel Management when required by law Sharing & Disclosure
GR-67806-17 (2-26) Federal Risk Plans 2
We may disclose your protected health information to the U.S. Office of Personnel Management (OPM) in connection with payment or healthcare operations when required by law.
- Aetna may disclose PHI to the U.S. Office of Personnel Management when required by law Sharing & Disclosure
Payment: We may use and disclose PHI to help pay for your covered services when:
- Aetna may use and disclose PHI to pay for your covered services Use & Processing
- Doing utilization and medical necessity reviews
- Aetna may use and disclose PHI to pay for your covered services Use & Processing
- Coordinating care
- Aetna may use and disclose PHI to pay for your covered services Use & Processing
- Deciding eligibility
- Aetna may use and disclose PHI to pay for your covered services Use & Processing
- Deciding on drug list (formulary) compliance
- Aetna may use and disclose PHI to pay for your covered services Use & Processing
- Getting premium payments from you
- Aetna may use and disclose PHI to pay for your covered services Use & Processing
- Calculating cost-sharing amounts
- Aetna may use and disclose PHI to pay for your covered services Use & Processing
- Responding to complaints, appeals and requests for external reviews We carry out these tasks to make sure we pay for your care the right way.
- Aetna may use and disclose PHI to pay for your covered services Use & Processing
We may use your health history and other PHI to decide whether a treatment is medically necessary and what the payment should be. During this process, we may share information with your health care provider.
- Aetna may use your health history to decide medical necessity and payment, and share information with your provider Use & Processing
We may also mail Explanation of Benefits forms and other information to the address we have on file for the subscriber (i.e., the primary insured). We also make claims information on our secure member website and telephonic claims status sites available to the subscriber and all covered dependents. We also use PHI to get payment for any mail-order pharmacy services you get.
- Explanation of Benefits mail and online claims information go to the subscriber and covered dependents Sharing & Disclosure
- You can ask Aetna to communicate with you how or where you choose Account & Service Control
Treatment: We may share your PHI with the health care providers who take care of you like your doctors, dentists, pharmacies and hospitals. Sometimes doctors may ask for your medical information from us to put in their own records.
- Aetna may share PHI with your treating providers and for treatment-related reasons Sharing & Disclosure
We may also use your information to offer you mail-order pharmacy services. And we may also share certain information for patient safety or other reasons linked to your treatment.
- Aetna may share PHI with your treating providers and for treatment-related reasons Sharing & Disclosure
Disclosures to other covered entities: We may share your PHI with other covered entities or their business associates. This may be for treatment, payment, or for certain health care operations.
- Aetna may share PHI with other covered entities and their business associates Sharing & Disclosure
For example, you may get your health benefits through an employer. If so, we may share your PHI with other health plans your employer offers. We do this to make sure we pay your claims the right way.
- Aetna may share PHI with other covered entities and their business associates Sharing & Disclosure
Additional Reasons for Disclosure
We may use or share PHI about you in providing you with treatment alternatives, treatment reminders, or other health-related benefits and services. We also may share such information in support of:
- Aetna may use or share PHI for treatment alternatives, reminders and health-related benefits and services Use & Processing
- Plan Administration (Group Plans) – to your employer, as applicable, when we have been informed that appropriate language has been included in your plan documents, or when summary data is disclosed to assist in bidding or amending a group health plan.
- Research – to researchers, provided measures are taken to protect your privacy.
- Aetna may share PHI with researchers if measures protect your privacy Sharing & Disclosure
- Business Associates – to persons who provide services to us and assure us they will protect the information.
- Aetna may share PHI with business associates who promise to protect it Sharing & Disclosure
- Industry Regulation – to Government agencies that regulate us (different countries and U.S. state insurance departments).
- Aetna may share PHI with government agencies that regulate it Sharing & Disclosure
- Workers’ Compensation – to comply with workers’ compensation laws.
- Law Enforcement – to Government law enforcement officials.
- Legal Proceedings – in response to a court order or other lawful process.
- Public Welfare – to address matters of public interest as required or permitted by law (e.g., child abuse and neglect, threats to public health and safety, and national security).
- As Required by Law – to comply with legal obligations and requirements.
- Decedents – to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death, or as authorized by law; and to funeral directors as necessary to carry out their duties.
- Aetna may share PHI with coroners, funeral directors and organ donation groups Sharing & Disclosure
- Organ Procurement – to respond to organ donation groups for the purpose of facilitating donation and transplantation.
- Aetna may share PHI with coroners, funeral directors and organ donation groups Sharing & Disclosure
Times when we must share your information
There are times when we must share your PHI. When required, we must release it to:
- Aetna must release PHI to you or your personal representative and to the Department of Health and Human Services Sharing & Disclosure
- You, or someone who has the legal right to act for you. This person is your personal representative. We do this to help manage your rights, as spelled out in this Notice.
- The Department of Health and Human Services. We may do this to comply with the Health Insurance Portability and Accountability Act (HIPAA). They may collect this information to enforce HIPAA.
When we may share your information with those involved in your care
We may share your PHI with people involved in your health care. We may also share with those involved in paying for your care. For example, if a family member or a caregiver calls us about a claim, we may tell them what stage it’s in. You have the right to stop or limit this kind of sharing (disclosure). To do so, just call the toll-free number on your member ID card. If you’re a minor, you may have the right to block parental views of your health information in certain cases. But you can only do so if state law allows it. You can call us at the toll-free number on your ID card. Or have your provider talk to us.
- Aetna may share PHI with people involved in your health care or in paying for it Sharing & Disclosure
- You can stop or limit sharing with people involved in your care; minors may block parental views if state law allows Sharing & Disclosure
- You can ask Aetna to limit uses and sharing, but it may not agree Use & Processing
When we need your okay to use or share your information
If we have not described a use or disclosure above, we will need you to say it’s okay in writing to use or disclose your PHI. For example, we will get your okay:
- Aetna needs your written okay for uses and disclosures the Notice does not describe Use & Processing
- For marketing purposes unrelated to your benefit plan(s)
- Before sharing any psychotherapy notes
- When linked to the sale of your PHI
- For other reasons as required by law
Even if you gave us your okay, you can withdraw it anytime. You just need to let us know in writing. If we haven’t already acted on it, we’ll stop using or sharing your information for that purpose. If you have questions about written permission, just call the toll-free number on your ID card.
- You can withdraw your written permission any time, in writing Use & Processing
PHI disclosed as permitted by HIPAA may be subject to redisclosure by the recipient and no longer protected by HIPAA.
- Recipients may redisclose PHI and it may no longer be protected by HIPAA Sharing & Disclosure
Additional Restrictions on Use and Disclosure
Some state and federal laws may require special privacy protections, including certain requirements to obtain attestations from requestors, that limit the use and disclosure of certain sensitive health information. Such laws may protect information related to:
- Some laws add protections for sensitive health information, and Aetna says it will follow the stricter law Legal Rights & Agreement Rules
- Alcohol or substance use disorder
- Some laws add protections for sensitive health information, and Aetna says it will follow the stricter law Legal Rights & Agreement Rules
- Biometric Information
- Some laws add protections for sensitive health information, and Aetna says it will follow the stricter law Legal Rights & Agreement Rules
- Child or adult abuse or neglect, including sexual assault
- Some laws add protections for sensitive health information, and Aetna says it will follow the stricter law Legal Rights & Agreement Rules
- Communicable diseases
- Some laws add protections for sensitive health information, and Aetna says it will follow the stricter law Legal Rights & Agreement Rules
- Genetic information
- Some laws add protections for sensitive health information, and Aetna says it will follow the stricter law Legal Rights & Agreement Rules
- HIV/AIDs
- Some laws add protections for sensitive health information, and Aetna says it will follow the stricter law Legal Rights & Agreement Rules
- Mental health
- Some laws add protections for sensitive health information, and Aetna says it will follow the stricter law Legal Rights & Agreement Rules
- Minors
- Some laws add protections for sensitive health information, and Aetna says it will follow the stricter law Legal Rights & Agreement Rules
- Reproductive health
- Some laws add protections for sensitive health information, and Aetna says it will follow the stricter law Legal Rights & Agreement Rules
- Sexually transmitted diseases
- Some laws add protections for sensitive health information, and Aetna says it will follow the stricter law Legal Rights & Agreement Rules
We will follow the law that is stricter (or more protective of your PHI), where it applies to us. If you would like additional information about additional use or disclosure restrictions that may apply to your sensitive PHI, please contact the Aetna Privacy Office.
- Some laws add protections for sensitive health information, and Aetna says it will follow the stricter law Legal Rights & Agreement Rules
Substance Use Disorder Information
We are not a substance use disorder treatment program. We may receive or keep information about you that comes from a substance use disorder program. If a substance use disorder program provides us this information through a 42 CFR Part 2 consent, including a consent for future uses and disclosures for treatment, payment, and health care operations, we will use or share that information in accordance with both the consent and HIPAA. In limited situations where we may disclose this information without your permission, such as medical emergencies and government audits, we will follow the law that is more protective of your information. We will not use or share this information in any legal case against you unless:
- Aetna may hold substance use disorder program information and follows consent and the more protective law Use & Processing
- Aetna will not use substance use disorder information against you in a legal case without consent or a court order Legal Rights & Agreement Rules
- You give us written consent, or
- Aetna will not use substance use disorder information against you in a legal case without consent or a court order Legal Rights & Agreement Rules
- A court orders us with a subpoena or other legal requirement.
- Aetna will not use substance use disorder information against you in a legal case without consent or a court order Legal Rights & Agreement Rules
You or Aetna must also receive notice and a chance to be heard.
- Aetna will not use substance use disorder information against you in a legal case without consent or a court order Legal Rights & Agreement Rules
Your rights under the law
Under federal privacy laws, you have rights when it comes to your PHI. You have the right to:
- Under federal privacy laws you have rights about your PHI Legal Rights & Agreement Rules
- Ask us to communicate with you how or where you choose. For example, if you’re covered as an adult dependent, you might want us to send health information, like your Explanation of Benefits, to another address than that of your subscriber. If it’s a reasonable request, we will make this happen.
- You can ask Aetna to communicate with you how or where you choose Account & Service Control
- Ask us to limit the way we use or share your information when it comes to health care operations, payment and treatment. We will consider, but may not agree to, such requests. You also have the right to ask us to restrict sharing with people involved in your health care.
- You can ask Aetna to limit uses and sharing, but it may not agree Use & Processing
- Ask us for a copy of PHI that’s part of a “designated record set”. This may include medical records. It may also include other records we keep and use for: Enrollment
Payment
- You can ask for a copy of PHI in your designated record set; Aetna may charge a reasonable fee or deny the request Account & Service Control
Claims processing
- You can ask for a copy of PHI in your designated record set; Aetna may charge a reasonable fee or deny the request Account & Service Control
Medical management
- You can ask for a copy of PHI in your designated record set; Aetna may charge a reasonable fee or deny the request Account & Service Control
Other decisions
- You can ask for a copy of PHI in your designated record set; Aetna may charge a reasonable fee or deny the request Account & Service Control
We may ask you to request this in writing. And we may charge a reasonable fee for making and mailing the copies. Sometimes, we may deny the request.
- You can ask for a copy of PHI in your designated record set; Aetna may charge a reasonable fee or deny the request Account & Service Control
- You can make the requests, ask for a paper copy of the Notice or ask questions by calling the member ID card number Account & Service Control
- Ask us to fix your PHI. You need to ask this in writing. And you must include the reason for the request. If we deny it, you may write us, to let us know you disagree.
- You can ask Aetna in writing, with a reason, to fix your PHI Account & Service Control
- You can make the requests, ask for a paper copy of the Notice or ask questions by calling the member ID card number Account & Service Control
- Ask us to give you a list of certain disclosures we have made about you, such as PHI we’ve shared with government agencies that license us. (This is called an “accounting.”) You need to ask this in writing. If you ask for this kind of list more than once in 12 months, we may charge a reasonable fee.
- Be notified after a breach of your PHI.
- You have the right to be notified after a breach of your PHI Security & Safeguards
- Know the reasons for denying an insurance policy or other unfavorable underwriting decision. If you’ve been denied a policy in the past, we can’t use that information in our decision process. We must review the facts on our own. Also, we can’t use your genetic information to decide if we should issue you a policy or for other underwriting purposes.
- Insurers aren’t allowed to take part in pretext interviews, except in some cases, such as suspected fraud or criminal activity. We don’t take part in these. You may make any of the above requests (if they apply), ask for a paper copy of this Notice, or ask questions about this Notice. You can do this by calling the toll-free number on your member ID card.
- Aetna says insurers may not take part in pretext interviews except in some cases, and Aetna does not take part Legal Rights & Agreement Rules
- You can make the requests, ask for a paper copy of the Notice or ask questions by calling the member ID card number Account & Service Control
You also have the right to file a complaint if you think someone has violated your privacy rights. To do so, just send an email to Aetna Privacy Office at PrivacyAetna@aetna.com or
- You can file a complaint with Aetna's Privacy Office or by mail, or write to the Secretary of Health and Human Services Legal Rights & Agreement Rules
send a letter to: Aetna HIPAA Member Rights Team P.O. Box 14079
- You can file a complaint with Aetna's Privacy Office or by mail, or write to the Secretary of Health and Human Services Legal Rights & Agreement Rules
Lexington, KY 40512-4079 Fax: 859-280-1272
- You can file a complaint with Aetna's Privacy Office or by mail, or write to the Secretary of Health and Human Services Legal Rights & Agreement Rules
You may stop the paper mailing of your EOB and other claim information by visiting Aetna.com. Choose “Log In/Register.” Follow the prompts to complete the one-time registration. Then you can log in anytime to view your EOBs and other claim information. You also may write to the Secretary of the U.S. Department of Health and Human Services. There are no penalties for filing a complaint.
- You can file a complaint with Aetna's Privacy Office or by mail, or write to the Secretary of Health and Human Services Legal Rights & Agreement Rules
- You can stop paper mailing of Explanation of Benefits by registering on Aetna.com Account & Service Control
How we keep your information safe
We use administrative, technical and physical safeguards to keep your information from unauthorized access, and other threats and hazards to its security and integrity. We comply with all state and federal laws that apply related to the security and confidentiality of your PHI. We don’t destroy your PHI even when you end your coverage with us. We may need to use and share it even after your coverage terminates. (We describe the reasons for using or sharing in this Notice). We will continue to protect your information against inappropriate use or disclosure.
- Aetna uses administrative, technical and physical safeguards and says it complies with applicable security laws Security & Safeguards
- Aetna keeps your PHI after you end coverage, may still use and share it, and says it will keep protecting it Retention & Deletion
How we comply with the law
Federal privacy law requires us to keep your PHI private. And we must tell you about our legal duties and privacy practices. We must also follow the terms of the Notice in effect.
- Federal law requires Aetna to keep your PHI private, tell you its duties and follow the Notice in effect Legal Rights & Agreement Rules
When this Notice may change
We may change the terms of this Notice and our privacy policies anytime. If we do, the new terms and policies will be effective for all the information we now have about you. And they’ll apply to any information that we may get or hold in the future.
- Aetna may change the Notice and its privacy policies at any time, and changes apply to all information it holds or gets Legal Rights & Agreement Rules
Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).
- Aetna is described as a brand name used by the Aetna group of companies Legal Rights & Agreement Rules