The Notice covers Aetna Life Insurance Company and its affiliated covered entity
This Notice of Privacy Practices describes the privacy practices of Aetna Life Insurance Company. In the Notice, "Aetna", "we", "us" and "our" mean all of the HMO and licensed insurer subsidiaries of Aetna Inc., which are designated as a single affiliated covered entity (the Aetna ACE) for federal privacy purposes. Members of the Aetna ACE can share Protected Health Information (PHI) with each other for the treatment, payment and health care operations of the Aetna ACE and as HIPAA and this Notice allow. The Notice says what medical information about you may be used and disclosed and how you can get access to it.
Supporting quotations
This Notice of Privacy Practices (Notice) describes the privacy practices of Aetna Life Insurance Company.
refer to all of the HMO and licensed insurer subsidiaries of Aetna Inc.
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.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
Qualifications & exceptions
Sharing among ACE members is for treatment, payment and health care operations of the Aetna ACE and as allowed by HIPAA and this Notice.
Not stated here
The list of ACE members is not in the Notice; it is available by contacting the Aetna Privacy Office at the email given in the Notice.
A later paragraph describes the Aetna brand more broadly than this definition of "Aetna".
Cross-references
contrast (model-proposed): Aetna is described as a brand name used by the Aetna group of companies — contrast: The opening defines Aetna as the HMO and licensed insurer subsidiaries of Aetna Inc. designated as one affiliated covered entity. The closing line describes Aetna as a brand name used by one or more companies in the Aetna group, including Aetna Life Insurance Company and its affiliates. The Notice does not say whether these are the same set of entities.
Legal Rights & Agreement Rules · Restriction or exception
The Notice applies to insured plans, not employer self-funded plans
This Notice is for Aetna insured health benefit plans. It does not apply to plans that an employer self-funds. If you have coverage through work, the Notice says to ask your employer whether the plan is insured or self-funded, and, if it is self-funded, to ask for a copy of your employer's Privacy Notice.
Supporting quotations
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 it’s self-funded, ask for a copy of your employer’s Privacy Notice.
Qualifications & exceptions
Applies to insured plans only; plans self-funded by an employer are outside the Notice.
Not stated here
The Notice does not say what the label "Federal Risk Plans" in its footer covers beyond appearing as a form label.
Legal Rights & Agreement Rules · Context
The Notice took effect on October 1, 2025
The Notice states that it took effect on October 1, 2025. A form code in the footer, GR-67806-17 (2-26) Federal Risk Plans, also appears; the Notice does not explain what the "(2-26)" part means or whether it relates to the effective date.
Supporting quotations
Effective date: This Notice took effect on October 1, 2025.
GR-67806-17 (2-26) Federal Risk Plans
Qualifications & exceptions
The only stated date is the October 1, 2025 effective date.
Not stated here
The footer form code includes "(2-26)"; the Notice does not say what it means or whether a later revision applies.
Account & Service Control · Procedure
You can get this Notice in Spanish by calling the number on your member ID card
To receive the Notice in Spanish, call the toll-free number on your member ID card (Member Services). The Notice gives this instruction in both Spanish and English.
Supporting quotations
To receive this Notice in Spanish, please call the toll-free number on your member ID card.
Para recibir esta notificación en español por favor llamar al número gratuito de Member Services (Servicios a Miembros)
Data Access & Collection · Company practice
Aetna gets your information from you and from employers, insurers, administrators and providers
Aetna gets information about you from many sources, including from you. It can also 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.
Supporting quotations
We get information about you from many sources, including from you.
it from your employer or benefits plan sponsor (if applicable), other insurers, HMOs or third-party administrators, and health care providers such as doctors.
Qualifications & exceptions
Employer or benefits plan sponsor is a source only "if applicable".
Not stated here
"Many sources" is not limited to the examples listed.
Data Access & Collection · Context
PHI includes identifying non-public information and health, coverage and test details
The Notice calls this information Protected Health Information (PHI). It includes personal information that may identify you and is not public, and information about your health, medical conditions and prescriptions. It may include demographic data such as your name or address, health details such as a medical history, test results such as a lab test, insurance information such as your member ID, and other information used to identify you or linked to your health care or health care coverage.
Supporting quotations
It includes personal information that may identify you that is not public information.
And it includes information about your health, medical conditions and prescriptions.
Demographic data (like your name or address)
Health details (like a medical history)
Test results (like a lab test)
Insurance information (like your member ID)
Other information used to identify you or that’s linked to your health care or health care coverage
Qualifications & exceptions
The list is introduced with "It may include", so it is not a complete list.
Use & Processing · Permission or license
Aetna may use and share PHI for its health care operations
Aetna may use and share your PHI for its health care operations, which the Notice describes as actions needed to run its health business. The listed examples are quality assessment and improvement, licensing, accreditation by independent organizations, performance measurement and outcomes assessment, health services research, and preventive health, disease and case management, and care coordination. For the last item the Notice gives the example of using your PHI to offer programs for certain conditions, such as diabetes, asthma or heart failure.
Supporting quotations
We may use and share your PHI for our health care operations.
Those are actions we need to do to run our health business, including:
Quality assessment and improvement
Licensing
Accreditation by independent organizations
Performance measurement and outcomes assessment
Health services research
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.
Qualifications & exceptions
The permission is "may", not a commitment to do each activity.
The list is introduced with "including", so it is not a complete list.
Use & Processing · Permission or license
Other operations include underwriting, fraud investigation, reinsurance and company sale or merger due diligence
Aetna may also use PHI for other operations that require use and disclosure, listed 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; and performing other general administrative activities, including data and information systems management and customer service. Elsewhere the Notice says Aetna cannot use genetic information to decide whether to issue a policy or for other underwriting purposes.
Supporting quotations
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)
Qualifications & exceptions
The list is introduced with "such as", so it is not a complete list.
The rights section says Aetna cannot use genetic information for underwriting purposes.
Sharing & Disclosure · Permission or license
Aetna may disclose PHI to the U.S. Office of Personnel Management when required by law
Aetna may disclose your PHI to the U.S. Office of Personnel Management (OPM) in connection with payment or health care operations when required by law. It may also disclose your PHI to OPM for the Federal Employees Health Benefits (FEHB) Program and Postal Service Health Benefits (PSHB) Program Claims Data Warehouse when required by law. The first sentence appears in the saved text twice, once split across a page break and once after a page footer.
Supporting quotations
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
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.
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.
Qualifications & exceptions
Both OPM disclosures are conditioned on being required by law.
Not stated here
The Notice does not define the "Federal Risk Plans" label or say which federal programs it ties to this notice beyond the OPM, FEHB and PSHB references.
Use & Processing · Permission or license
Aetna may use and disclose PHI to pay for your covered services
Aetna may use and disclose PHI to help pay for your covered services in activities such as utilization and medical necessity reviews, coordinating care, deciding eligibility, deciding drug list (formulary) compliance, getting premium payments from you, calculating cost-sharing amounts, and responding to complaints, appeals and requests for external reviews. The Notice says these tasks are carried out to make sure Aetna pays for your care the right way.
Supporting quotations
We may use and disclose PHI to help pay for your covered services when:
Doing utilization and medical necessity reviews
Coordinating care
Deciding eligibility
Deciding on drug list (formulary) compliance
Getting premium payments from you
Calculating cost-sharing amounts
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.
Qualifications & exceptions
The permission is "may" and is tied to payment for covered services.
Use & Processing · Company practice
Aetna may use your health history to decide medical necessity and payment, and share information with your provider
Aetna 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, it may share information with your health care provider.
Supporting quotations
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.
Qualifications & exceptions
Written as "may".
Sharing & Disclosure · Company practice
Explanation of Benefits mail and online claims information go to the subscriber and covered dependents
Aetna may mail Explanation of Benefits forms and other information to the address it has on file for the subscriber (the primary insured). It also makes claims information available on its secure member website and telephonic claims status sites to the subscriber and all covered dependents. It also uses PHI to get payment for any mail-order pharmacy services you get. The Notice separately says you can ask Aetna to communicate with you at another address, such as for an adult dependent, and can stop the paper mailing of EOBs by registering on Aetna.com.
Supporting quotations
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.
Qualifications & exceptions
Mailing goes to the subscriber's address on file, not a dependent's address, unless a different address is requested under the rights section.
Not stated here
The Notice does not say how much of a dependent's claims information the subscriber or other dependents see online or by phone.
Sharing & Disclosure · Permission or license
Aetna may share PHI with your treating providers and for treatment-related reasons
Aetna may share your PHI with the health care providers who take care of you, such as doctors, dentists, pharmacies and hospitals. Sometimes doctors may ask Aetna for your medical information to put in their own records. Aetna may also use your information to offer you mail-order pharmacy services, and may share certain information for patient safety or other reasons linked to your treatment.
Supporting quotations
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.
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.
Qualifications & exceptions
Sharing is with providers who take care of you.
Not stated here
"Other reasons linked to your treatment" is not defined.
Sharing & Disclosure · Permission or license
Aetna may share PHI with other covered entities and their business associates
Aetna may share your PHI with other covered entities or their business associates for treatment, payment or certain health care operations. As an example, if you get your health benefits through an employer, Aetna may share your PHI with other health plans your employer offers, to make sure it pays your claims the right way.
Supporting quotations
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.
For example, you may get your health benefits through an employer.
we may share your PHI with other health plans your employer offers.
Qualifications & exceptions
Purposes are limited to treatment, payment or certain health care operations.
The employer example applies if you get benefits through an employer.
Use & Processing · Permission or license
Aetna may use or share PHI for treatment alternatives, reminders and health-related benefits and services
Aetna may use or share PHI about you in providing you with treatment alternatives, treatment reminders, or other health-related benefits and services. The same paragraph introduces a list of further disclosures that Aetna may make in support of plan administration, research, business associates, regulation, workers' compensation, law enforcement, legal proceedings, public welfare, legal requirements, decedents and organ procurement.
Supporting quotations
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:
Qualifications & exceptions
Written as "may".
Sharing & Disclosure · Permission or license
Aetna may share PHI with your employer for plan administration when plan documents allow
For plan administration of group plans, Aetna may share PHI with your employer, as applicable, when Aetna has 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.
Supporting quotations
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.
Qualifications & exceptions
Applies to group plans and to the employer "as applicable".
Condition one: Aetna has been informed that appropriate language is in the plan documents. Condition two: summary data is disclosed to assist in bidding or amending a group health plan.
Not stated here
The Notice does not describe what the "appropriate language" is or what summary data contains.
Sharing & Disclosure · Permission or license
Aetna may share PHI with researchers if measures protect your privacy
Aetna may share PHI with researchers, provided measures are taken to protect your privacy.
Supporting quotations
Research – to researchers, provided measures are taken to protect your privacy.
Qualifications & exceptions
Conditioned on measures being taken to protect your privacy.
Not stated here
The Notice does not say what those measures are or who takes them.
Sharing & Disclosure · Permission or license
Aetna may share PHI with business associates who promise to protect it
Aetna may share PHI with persons who provide services to it and assure Aetna they will protect the information.
Supporting quotations
Business Associates – to persons who provide services to us and assure us they will protect the information.
Qualifications & exceptions
The recipients must provide services to Aetna and assure it they will protect the information.
Sharing & Disclosure · Permission or license
Aetna may share PHI with government agencies that regulate it
Aetna may share PHI with government agencies that regulate it, described as agencies of different countries and U.S. state insurance departments.
Supporting quotations
Industry Regulation – to Government agencies that regulate us (different countries and U.S. state insurance departments).
Qualifications & exceptions
Recipients are regulators of Aetna.
Sharing & Disclosure · Permission or license
Aetna may share PHI for workers' compensation, law enforcement, legal proceedings, public welfare and legal requirements
Aetna may share PHI to comply with workers' compensation laws; with government law enforcement officials; in response to a court order or other lawful process; to address matters of public interest as required or permitted by law, with the examples given being child abuse and neglect, threats to public health and safety, and national security; and to comply with legal obligations and requirements.
Supporting quotations
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.
Qualifications & exceptions
Legal proceedings: in response to a court order or other lawful process.
Public welfare: as required or permitted by law; the examples are illustrative.
Not stated here
The law enforcement item states no further condition or legal process requirement.
Sharing & Disclosure · Permission or license
Aetna may share PHI with coroners, funeral directors and organ donation groups
Aetna may share PHI with a coroner or medical examiner to identify a deceased person, determine a cause of death, or as authorized by law, and with funeral directors as necessary to carry out their duties. It may also respond to organ donation groups to facilitate donation and transplantation.
Supporting quotations
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.
Organ Procurement – to respond to organ donation groups for the purpose of facilitating donation and transplantation.
Qualifications & exceptions
Funeral directors: as necessary to carry out their duties.
Sharing & Disclosure · Company commitment
Aetna must release PHI to you or your personal representative and to the Department of Health and Human Services
When required, Aetna must release PHI to you or to someone with the legal right to act for you, your personal representative, to help manage your rights under the Notice. It must also release PHI to the Department of Health and Human Services, which may collect it to enforce HIPAA, to comply with HIPAA.
Supporting quotations
There are times when we must share your PHI.
You, or someone who has the legal right to act for you.
The Department of Health and Human Services.
Qualifications & exceptions
Applies "when required".
Sharing & Disclosure · Permission or license
Aetna may share PHI with people involved in your health care or in paying for it
Aetna may share your PHI with people involved in your health care and with those involved in paying for your care. For example, if a family member or a caregiver calls about a claim, Aetna may tell them what stage it is in.
Supporting quotations
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.
Qualifications & exceptions
The example is about claim status; the Notice does not limit the sharing to that example.
Sharing & Disclosure · User right or choice
You can stop or limit sharing with people involved in your care; minors may block parental views if state law allows
The Notice says you have the right to stop or limit sharing with people involved in your health care or paying for it, by calling the toll-free number on your member ID card. If you are a minor, you may have the right to block parental views of your health information in certain cases, but only if state law allows it. You can call the toll-free number on your ID card, or have your provider talk to Aetna.
Supporting quotations
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.
Or have your provider talk to us.
Qualifications & exceptions
For minors, the right applies only in certain cases and only if state law allows it.
The rights section describes this as a right to "ask" Aetna to restrict sharing; see the related card there.
Not stated here
Which cases let a minor block parental views is not stated.
Cross-references
contrast (model-proposed): You can ask Aetna to limit uses and sharing, but it may not agree — contrast: The sharing section says you have the right to stop or limit sharing with people involved in your care. The rights section says you may ask Aetna to restrict that sharing, and says Aetna may not agree to requests to limit uses and sharing for operations, payment and treatment. The Notice does not say which wording governs the involved-in-care sharing.
Use & Processing · Company commitment
Aetna needs your written okay for uses and disclosures the Notice does not describe
If a use or disclosure is not described in the Notice, Aetna says it will need you to say in writing that it is okay to use or disclose your PHI. Examples where Aetna will get your okay are marketing purposes unrelated to your benefit plan(s), before sharing any psychotherapy notes, when linked to the sale of your PHI, and for other reasons as required by law.
Supporting quotations
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 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
Qualifications & exceptions
Written permission is required for uses and disclosures that were not described.
Marketing needs permission only when it is unrelated to your benefit plans.
The examples are introduced with "For example".
Use & Processing · User right or choice
You can withdraw your written permission any time, in writing
Even if you gave your okay, you can withdraw it at any time by letting Aetna know in writing. If Aetna has not already acted on it, it will stop using or sharing your information for that purpose. You can call the toll-free number on your ID card with questions about written permission.
Supporting quotations
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.
Qualifications & exceptions
Withdrawal must be in writing.
Aetna stops only if it has not already acted on the permission.
Sharing & Disclosure · Context
Recipients may redisclose PHI and it may no longer be protected by HIPAA
PHI that Aetna discloses as HIPAA permits may be redisclosed by the recipient and may no longer be protected by HIPAA.
Supporting quotations
PHI disclosed as permitted by HIPAA may be subject to redisclosure by the recipient and no longer protected by HIPAA.
Qualifications & exceptions
Applies to PHI disclosed as permitted by HIPAA.
Legal Rights & Agreement Rules · Restriction or exception
Some laws add protections for sensitive health information, and Aetna says it will follow the stricter law
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. The Notice lists information related to alcohol or substance use disorder, biometric information, child or adult abuse or neglect including sexual assault, communicable diseases, genetic information, HIV/AIDS, mental health, minors, reproductive health, and sexually transmitted diseases. Aetna says it will follow the law that is stricter, or more protective of your PHI, where it applies to Aetna. For more information about these restrictions on your sensitive PHI, contact the Aetna Privacy Office.
Supporting quotations
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.
Alcohol or substance use disorder
Biometric Information
Child or adult abuse or neglect, including sexual assault
Communicable diseases
Genetic information
HIV/AIDs
Mental health
Minors
Reproductive health
Sexually transmitted diseases
We will follow the law that is stricter (or more protective of your PHI), where it applies to us.
Qualifications & exceptions
The laws "may" apply; the Notice does not name them or say when they apply to Aetna.
Aetna follows the stricter law only "where it applies to us".
Not stated here
The specific state and federal laws are not identified, and the Notice does not say what attestations are required.
Use & Processing · Company commitment
Aetna may hold substance use disorder program information and follows consent and the more protective law
Aetna says it is not a substance use disorder treatment program but may receive or keep information that comes from one. If a program provides the information through a 42 CFR Part 2 consent, including a consent for future uses and disclosures for treatment, payment and health care operations, Aetna will use or share it in accordance with both the consent and HIPAA. In limited situations where it may disclose this information without your permission, such as medical emergencies and government audits, Aetna will follow the law that is more protective of your information.
Supporting quotations
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.
Qualifications & exceptions
Use follows both the Part 2 consent and HIPAA.
The without-permission examples (medical emergencies, government audits) are introduced with "such as".
Not stated here
The Notice cites 42 CFR Part 2 by name only and does not explain it; the cited rule is not supplied as evidence.
Legal Rights & Agreement Rules · Restriction or exception
Aetna will not use substance use disorder information against you in a legal case without consent or a court order
Aetna will not use or share this substance use disorder information in any legal case against you unless you give written consent, or a court orders Aetna with a subpoena or other legal requirement. The Notice adds that you or Aetna must also receive notice and a chance to be heard.
Supporting quotations
We will not use or share this information in any legal case against you unless:
You give us written consent, or
A court orders us with a subpoena or other legal requirement.
You or Aetna must also receive notice and a chance to be heard.
Qualifications & exceptions
Exceptions: your written consent, or a court order with a subpoena or other legal requirement.
Notice and a chance to be heard must also be given to you or Aetna.
Legal Rights & Agreement Rules · Context
Under federal privacy laws you have rights about your PHI
The Notice says that under federal privacy laws you have rights when it comes to your PHI, and then lists them: choosing how or where Aetna communicates with you, asking Aetna to limit uses and sharing, getting a copy, asking to fix it, getting a list of certain disclosures, being notified after a breach, learning the reasons for denial of a policy, and limits on pretext interviews.
Supporting quotations
Under federal privacy laws, you have rights when it comes to your PHI.
Qualifications & exceptions
The individual rights are carded separately with their own conditions.
Account & Service Control · User right or choice
You can ask Aetna to communicate with you how or where you choose
You can ask Aetna to communicate with you how or where you choose. For example, if you are covered as an adult dependent, you might want health information such as your Explanation of Benefits sent to an address other than your subscriber's. If it is a reasonable request, Aetna says it will make this happen. By default, the Notice says Explanation of Benefits forms are mailed to the subscriber's address on file.
Supporting quotations
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.
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).
Qualifications & exceptions
Aetna says it will comply only if the request is reasonable.
Not stated here
The Notice does not define what makes a request reasonable.
You can ask Aetna to limit uses and sharing, but it may not agree
You can ask Aetna to limit how it uses or shares your information for health care operations, payment and treatment. Aetna says it will consider, but may not agree to, such requests. The Notice also says you have the right to ask Aetna to restrict sharing with people involved in your health care. Earlier, in the section on sharing with people involved in your care, the Notice says you have the right to stop or limit that kind of sharing. The two passages are worded differently and the Notice does not say whether Aetna may refuse a request to restrict sharing with people involved in your care.
Supporting quotations
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 have the right to stop or limit this kind of sharing (disclosure).
Qualifications & exceptions
For health care operations, payment and treatment, Aetna may decline the request.
Whether the "may not agree" sentence also applies to restricting sharing with people involved in your care is not stated.
Not stated here
The earlier section says you have the right to "stop or limit" sharing with people involved in your care; this section says you may "ask" to restrict it; the Notice does not reconcile the wording.
Account & Service Control · User right or choice
You can ask for a copy of PHI in your designated record set; Aetna may charge a reasonable fee or deny the request
You can ask Aetna for a copy of PHI that is part of a "designated record set". The Notice says this may include medical records and other records Aetna keeps and uses for enrollment, payment, claims processing, medical management and other decisions. Aetna may ask you to make the request in writing and may charge a reasonable fee for making and mailing the copies. Sometimes Aetna may deny the request.
Supporting quotations
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
Claims processing
Medical management
Other decisions
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.
Qualifications & exceptions
Aetna may require a written request.
Aetna may charge a reasonable fee for making and mailing copies.
Aetna may sometimes deny the request.
Not stated here
The Notice does not say when a request may be denied.
Account & Service Control · User right or choice
You can ask Aetna in writing, with a reason, to fix your PHI
You can ask Aetna to fix your PHI. You need to ask in writing and include the reason for the request. If Aetna denies it, you may write to Aetna to let it know you disagree.
Supporting quotations
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.
Qualifications & exceptions
The request must be in writing and include the reason.
Not stated here
The Notice does not say what happens after you write to say you disagree.
Account & Service Control · User right or choice
You can ask in writing for a list of certain disclosures; more than one request in 12 months may cost a fee
You can ask Aetna for a list of certain disclosures it has made about you, such as PHI shared with government agencies that license Aetna. The Notice calls this an "accounting". You need to ask in writing. If you ask for this kind of list more than once in 12 months, Aetna may charge a reasonable fee.
Supporting quotations
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.
Qualifications & exceptions
The request must be in writing.
A reasonable fee may apply if you ask more than once in 12 months.
Not stated here
The Notice says "certain disclosures" and does not list which disclosures are excluded.
Security & Safeguards · User right or choice
You have the right to be notified after a breach of your PHI
The Notice lists as a right that you are notified after a breach of your PHI. It does not describe how or when Aetna gives the notice.
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Be notified after a breach of your PHI.
Not stated here
The Notice does not say how or when notification is given.
Use & Processing · User right or choice
You can know reasons for a denial, and Aetna cannot use past denials or genetic information in underwriting
You have the right to know the reasons for denying an insurance policy or another unfavorable underwriting decision. If you were denied a policy in the past, Aetna says it cannot use that information in its decision process and must review the facts on its own. Aetna also says it cannot use your genetic information to decide whether to issue you a policy or for other underwriting purposes.
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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.
Qualifications & exceptions
The genetic-information limit covers deciding whether to issue a policy and other underwriting purposes.
Legal Rights & Agreement Rules · Company commitment
Aetna says insurers may not take part in pretext interviews except in some cases, and Aetna does not take part
The Notice says insurers are not allowed to take part in pretext interviews, except in some cases such as suspected fraud or criminal activity. It says Aetna does not take part in these.
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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.
Qualifications & exceptions
The general rule has exceptions in some cases, such as suspected fraud or criminal activity.
Not stated here
"Pretext interview" is not defined in the Notice.
Account & Service Control · Procedure
You can make the requests, ask for a paper copy of the Notice or ask questions by calling the member ID card number
You may make any of the requests above (if they apply), ask for a paper copy of the Notice, or ask questions about the Notice by calling the toll-free number on your member ID card. Other items in the same list say Aetna may ask for a copy request in writing and that asking to fix PHI or for a list of disclosures must be done in writing; the Notice does not say how the phone route fits with those items.
Supporting quotations
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.
We may ask you to request this in writing.
You need to ask this in writing.
You need to ask this in writing.
Qualifications & exceptions
Phone route covers requests "if they apply".
Copy requests may be required in writing; amendment and accounting requests must be in writing.
Not stated here
The Notice does not say how the phone route fits with the in-writing requirements for some requests.
Cross-references
contrast (model-proposed): You can ask Aetna in writing, with a reason, to fix your PHI — contrast: One item says you can make the listed requests by calling the toll-free number on your ID card, if they apply. The amendment item says you need to ask in writing. The Notice does not say how these fit together.
Legal Rights & Agreement Rules · User right or choice
You can file a complaint with Aetna's Privacy Office or by mail, or write to the Secretary of Health and Human Services
If you think someone has violated your privacy rights, you have the right to file a complaint. You can send an email to the Aetna Privacy Office, or send a letter to the Aetna HIPAA Member Rights Team at P.O. Box 14079, Lexington, KY 40512-4079; a fax number is listed with that address. You also may write to the Secretary of the U.S. Department of Health and Human Services. The Notice says there are no penalties for filing a complaint.
Supporting quotations
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
send a letter to: Aetna HIPAA Member Rights Team P.O. Box 14079
Lexington, KY 40512-4079 Fax: 859-280-1272
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.
Qualifications & exceptions
The complaint right applies if you think someone has violated your privacy rights.
Not stated here
The Notice lists a fax number with the mailing address but does not say whether complaints may be sent by fax.
Account & Service Control · Procedure
You can stop paper mailing of Explanation of Benefits by registering on Aetna.com
You may stop the paper mailing of your Explanation of Benefits and other claim information by visiting Aetna.com, choosing Log In/Register, and completing the one-time registration. Then you can log in anytime to view your EOBs and other claim information.
Supporting quotations
You may stop the paper mailing of your EOB and other claim information by visiting Aetna.com.
Follow the prompts to complete the one-time registration.
Then you can log in anytime to view your EOBs and other claim information.
Qualifications & exceptions
Requires completing the one-time registration on Aetna.com.
Aetna uses administrative, technical and physical safeguards and says it complies with applicable security laws
Aetna says it uses administrative, technical and physical safeguards to keep your information from unauthorized access and other threats and hazards to its security and integrity. It says it complies with all state and federal laws that apply related to the security and confidentiality of your PHI.
Supporting quotations
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.
Qualifications & exceptions
Compliance is with laws that apply.
Not stated here
The Notice does not describe the specific safeguards.
Retention & Deletion · Company practice
Aetna keeps your PHI after you end coverage, may still use and share it, and says it will keep protecting it
Aetna says it does not destroy your PHI even when you end your coverage. It may need to use and share it even after your coverage terminates, for the reasons the Notice describes. Aetna says it will continue to protect your information against inappropriate use or disclosure.
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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.
Qualifications & exceptions
Use and sharing after coverage ends are for the reasons described in the Notice.
Not stated here
The Notice gives no retention period or deletion process.
Legal Rights & Agreement Rules · Company commitment
Federal law requires Aetna to keep your PHI private, tell you its duties and follow the Notice in effect
Federal privacy law requires Aetna to keep your PHI private and to tell you about its legal duties and privacy practices. Aetna must also follow the terms of the Notice in effect.
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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.
Legal Rights & Agreement Rules · Permission or license
Aetna may change the Notice and its privacy policies at any time, and changes apply to all information it holds or gets
Aetna may change the terms of the Notice and its privacy policies anytime. If it does, the new terms and policies will be effective for all the information it now has about you and will apply to any information it may get or hold in the future.
Supporting quotations
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.
Qualifications & exceptions
Changes apply to existing information and information obtained in the future.
Not stated here
The Notice does not say how Aetna will tell you about a change or how much advance notice it gives.
Legal Rights & Agreement Rules · Context
Aetna is described as a brand name used by the Aetna group of companies
The Notice says 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. This brand description is broader than the definition at the start of the Notice, which says Aetna and "we" mean the HMO and licensed insurer subsidiaries of Aetna Inc. designated as a single affiliated covered entity.
Supporting quotations
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).
Not stated here
The Notice does not say whether the brand-name group of companies and the affiliated covered entity are the same set of entities.