May use health information to offer treatment alternatives, reminders and related benefits
Aetna may use or disclose health information about you in providing treatment alternatives, treatment reminders, or other health-related benefits and services.
Supporting quotations
We may use or disclose health information about you in providing you with treatment alternatives, treatment reminders, or other health-related benefits and services.
Qualifications & exceptions
Stated as "may"; a permission, not a promise to send any of these.
Use & Processing · Company practice
Information from substance use disorder programs is handled under the consent and HIPAA
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 this information through a 42 CFR Part 2 consent, including a consent for future uses and disclosures for treatment, payment and health care operations, Aetna says it 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, it says it will follow the law that is more protective of your information.
Supporting quotations
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.
Qualifications & exceptions
Applies to information that comes from a substance use disorder program.
Examples of disclosure without permission are introduced by "such as," so they are not an exhaustive list.
Not stated here
The notice does not describe how a consent is given or withdrawn, or which other situations allow disclosure without permission.
Use & Processing · User right or choice
You can ask Aetna to restrict uses and disclosures, but it may say no
You have the right to ask Aetna to restrict how it uses or discloses your health information for health care operations, payment and treatment. Aetna says it will consider, but may not agree to, such requests. You also have the right to ask it to restrict disclosures to persons involved in your health care; the notice's earlier section on others involved in your care says you can stop or limit that kind of disclosure by calling 1-800-264-4000.
Supporting quotations
You have the right to ask us to restrict the way we use or disclose health information about you in connection with 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 disclosures to persons involved in your health care.
Disclosure to Others Involved in Your Health Care
You have the right to stop or limit this kind of disclosure by calling the toll-free Privacy Compliance Department number at 1-800-264-4000.
Qualifications & exceptions
Aetna says it will consider but may not agree to restriction requests.
Not stated here
The two sections use different wording ("stop or limit" and "ask us to restrict"); the notice does not say whether Aetna must honor a request about persons involved in your care.
You can learn the reasons for an unfavorable underwriting decision; genetic information is not used for underwriting
You have the right to know the reasons for an unfavorable underwriting decision. Previous unfavorable underwriting decisions may not be used as the basis for future underwriting decisions unless Aetna makes an independent evaluation of the basic facts. Your genetic information cannot be used for underwriting purposes.
Supporting quotations
You have the right to know the reasons for an unfavorable underwriting decision. Previous unfavorable underwriting decisions may not be used as the basis for future underwriting decisions unless we make an independent evaluation of the basic facts. Your genetic information cannot be used for underwriting purposes.
Qualifications & exceptions
A prior unfavorable decision can be relied on only after an independent evaluation of the basic facts.
Use & Processing · Permission or license
May use and disclose information for running its health business, such as quality work and disease management
Aetna may use and disclose personal information while running its health business, in operational activities such as quality assessment and improvement, licensing, accreditation by independent organizations, performance measurement and outcomes assessment, health services research, and preventive health, disease management, case management and care coordination. Its example is using information to provide disease management programs for members with specific conditions such as diabetes, asthma, or heart failure.
Supporting quotations
In administering your health benefits we may use and disclose personal information about you in various ways, including:
Health Care Operations: We may use and disclose personal information during the course of running our health business – that is, during operational activities such as quality assessment and improvement; licensing; accreditation by independent organizations; performance measurement and outcomes assessment; health services research; and preventive health, disease management, case management and care coordination.
For example, we may use the information to provide disease management programs for members with specific conditions, such as diabetes, asthma, or heart failure.
Qualifications & exceptions
Stated as "may"; a permission, not a list of things Aetna always does.
Later sections limit these uses, including written-authorization, stricter-law and member-request rights.
Use & Processing · Permission or license
Operational uses include underwriting, fraud investigation, pharmacy programs and policy transfers
The notice lists further operational activities that require use and disclosure of information: administration of reinsurance and stop loss, underwriting and rating, detection and investigation of fraud, administration of pharmaceutical programs and payments, transfer of policies or contracts to and from other health plans, and other general administrative activities including data and information systems management and customer service.
Supporting quotations
In administering your health benefits we may use and disclose personal information about you in various ways, including:
Other operational activities requiring use and disclosure include administration of reinsurance and stop loss; underwriting and rating; detection and investigation of fraud; administration of pharmaceutical programs and payments; transfer of policies or contracts from and to other health plans;
and other general administrative activities, including data and information systems management, and customer service
Qualifications & exceptions
Presented as part of health care operations.
Not stated here
The notice does not describe what personal information is used for each activity.
Use & Processing · Permission or license
May use and disclose information to pay for covered services
To help pay for covered services, Aetna may use and disclose personal information in conducting utilization and medical necessity reviews, coordinating care, determining eligibility, determining formulary compliance, collecting premiums, calculating cost-sharing amounts, and responding to complaints, appeals and requests for external review. For example, it may use your medical history and other health information to decide whether a treatment is medically necessary and what the payment should be, and may disclose information to your provider during that process. It also uses personal information to obtain payment for any mail order pharmacy services provided to you.
Supporting quotations
In administering your health benefits we may use and disclose personal information about you in various ways, including:
Payment: To help pay for your covered services, we may use and disclose personal information in a number of ways – in conducting utilization and medical necessity reviews; coordinating care; determining eligibility; determining formulary compliance; collecting premiums; calculating cost-sharing amounts; and responding to complaints, appeals and requests for external review.
For example, we may use your medical history and other health information about you to decide whether a particular treatment is medically necessary and what the payment should be – and during the process, we may disclose information to your provider.
We also use personal information to obtain payment for any mail order pharmacy services provided to you.
Qualifications & exceptions
"In a number of ways" followed by a list; the list reads as examples.