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.
Sharing & Disclosure · Permission or license
May disclose to your employer for plan administration in limited situations
For group health insurance plans, Aetna may disclose health information to your employer for plan administration in two situations: when it has been informed that appropriate language has been included in the plan documents, or when only summary data is disclosed to assist in bidding or amending a group health plan.
Supporting quotations
We also may disclose such information in support of:
Plan Administration – to your employer (for group health insurance plans), 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 health insurance plans only.
Conditioned on either appropriate plan-document language or summary data only.
Not stated here
The notice does not say what the "appropriate language" must be.
Sharing & Disclosure · Permission or license
May disclose to researchers if measures protect your privacy
Aetna may disclose health information to researchers, provided measures are taken to protect your privacy.
Supporting quotations
We also may disclose such information in support of:
Research – to researchers, provided measures are taken to protect your privacy.
Qualifications & exceptions
Conditioned on privacy-protecting measures being taken.
Not stated here
The measures are not described.
Sharing & Disclosure · Permission or license
May disclose to service providers who assure they will protect it
Aetna may disclose health information to persons who provide services to it and assure it they will protect the information.
Supporting quotations
We also may disclose such information in support of:
Business Partners – to persons who provide services to us and assure us they will protect the information.
Qualifications & exceptions
Conditioned on the service provider assuring Aetna that it will protect the information.
Not stated here
The notice does not describe the kind of assurance or name the service providers.
Sharing & Disclosure · Permission or license
May disclose to regulators, for workers' compensation and as required by law
Aetna may disclose health information to state insurance departments, boards of pharmacy, the U.S. Food and Drug Administration, the U.S. Department of Labor and other government agencies that regulate it; to comply with workers' compensation laws; and to comply with legal obligations and requirements.
Supporting quotations
We also may disclose such information in support of:
Industry Regulation – to state insurance departments, boards of pharmacy, U.S. Food and Drug Administration, U.S. Department of Labor and other government agencies that regulate us.
Workers’ Compensation – to comply with workers’ compensation laws.
As Required by Law – to comply with legal obligations and requirements.
Qualifications & exceptions
The regulator list ends with "other government agencies that regulate us," so it is not limited to the named agencies.
Sharing & Disclosure · Permission or license
May disclose to law enforcement and in response to court orders or lawful process
Aetna may disclose health information to federal, state and local law enforcement officials, and in response to a court order or other lawful process.
Supporting quotations
We also may disclose such information in support of:
Law Enforcement – to federal, state, and local law enforcement officials.
Legal Proceedings – in response to a court order or other lawful process.
Qualifications & exceptions
The law enforcement item states no further condition in this text; the legal-proceedings item requires a court order or other lawful process.
Not stated here
The notice does not say what conditions apply to law enforcement requests.
Sharing & Disclosure · Permission or license
May disclose for matters of public interest as required or permitted by law
Aetna may disclose health information to address matters of public interest as required or permitted by law, such as child abuse and neglect, threats to public health and safety, and national security.
Supporting quotations
We also may disclose such information in support of:
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).
Qualifications & exceptions
Limited to what is required or permitted by law; the examples are introduced by "e.g." and are not exhaustive.
Sharing & Disclosure · Permission or license
May disclose to coroners, funeral directors and organ donation groups
Aetna may disclose health information to a coroner or medical examiner to identify a deceased person, determine a cause of death, or as authorized by law; to funeral directors as necessary to carry out their duties; and to organ donation groups to facilitate donation and transplantation.
Supporting quotations
We also may disclose such information in support of:
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 director disclosures are limited to what is necessary for their duties.
Sharing & Disclosure · Company commitment
Must disclose to you or your representative and to the federal health department
Aetna says it must use and disclose personal information to you or someone with the legal right to act for you (your personal representative) in order to administer your rights under the notice, and to the Secretary of the Department of Health and Human Services as necessary for HIPAA compliance and enforcement.
Supporting quotations
Required Disclosures: We must use and disclose your personal information in the following manner:
To you or someone who has the legal right to act for you (your personal representative) in order to administer your rights as described in this notice; and
To the Secretary of the Department of Health and Human Services, as necessary, for HIPAA compliance and enforcement purposes.
Qualifications & exceptions
Stated as "must," unlike the "may" disclosures above.
Disclosure to the federal health department is limited to what is necessary for HIPAA compliance and enforcement.
Sharing & Disclosure · Permission or license
May disclose to relatives, friends, the subscriber or others you identify when relevant to your care or payment
Aetna may disclose personal information to a relative, a friend, the subscriber of your health benefits plan or any other person you identify, provided the information is directly relevant to that person's involvement with your health care or payment for it. For example, if a family member or caregiver calls with prior knowledge of a claim, Aetna may confirm whether the claim has been received and paid.
Supporting quotations
Disclosure to Others Involved in Your Health Care
We may disclose personal information about you to a relative, a friend, the subscriber of your health benefits plan or any other person you identify, provided the information is directly relevant to that person’s involvement with your health care or payment for that care.
For example, if a family member or a caregiver calls us with prior knowledge of a claim, we may confirm whether or not the claim has been received and paid.
Qualifications & exceptions
Limited to information directly relevant to that person's involvement in your care or payment.
The recipient can be the plan subscriber, who may be a different person from the member.
Sharing & Disclosure · User right or choice
You can stop or limit disclosures to people involved in your care by phone
The notice says you have the right to stop or limit disclosures to relatives, friends, the subscriber and others involved in your care by calling the toll-free Privacy Compliance Department number, 1-800-264-4000.
Supporting quotations
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.
Minors may be able to block parental access if state law permits
If you are a minor, you may also have the right to block parental access to your health information in certain circumstances, if state law permits. You can contact Aetna at the toll-free Privacy Compliance Department number, 1-800-264-4000, or have your provider contact Aetna.
Supporting quotations
If you are a minor, you also may have the right to block parental access to your health information in certain circumstances, if permitted by state law. You can contact us using the toll-free Privacy Compliance Department number at 1-800-264-4000 – or have your provider contact us.
Qualifications & exceptions
Depends on "certain circumstances" and on state law permitting it.
Not stated here
The notice does not say which circumstances or which states' laws apply.
Legal Rights & Agreement Rules · Company commitment
Asks for written authorization for other uses, such as unrelated marketing, psychotherapy notes and sales
In all situations other than those the notice describes, Aetna says it will ask for your written authorization before using or disclosing your personal information. Its examples are marketing purposes unrelated to your benefit plan, before disclosing any psychotherapy notes, the sale of your health information, and other reasons required by law.
Supporting quotations
Uses and Disclosures Requiring Your Written Authorization
In all situations other than those described above, we will ask for your written authorization before using or disclosing personal information about you. For example, we will get your authorization:
for marketing purposes that are unrelated to your benefit plan(s),
before disclosing any psychotherapy notes,
related to the sale of your health information, and
for other reasons as required by law.
Qualifications & exceptions
The list is introduced by "for example," so it is illustrative.
Marketing is listed only when unrelated to your benefit plan(s).
Legal Rights & Agreement Rules · User right or choice
You can revoke an authorization in writing unless Aetna already acted on it
If you have given an authorization, you may revoke it in writing at any time, if Aetna has not already acted on it. Questions about authorizations can go to the toll-free Privacy Compliance Department number, 1-800-264-4000.
Supporting quotations
If you have given us an authorization, you may revoke it in writing at any time, if we have not already acted on it. If you have questions regarding authorizations, please call the toll-free Privacy Compliance Department number at 1-800-264-4000.
Qualifications & exceptions
Revocation must be in writing and does not undo something Aetna has already acted on.
Disclosed health information may be redisclosed and lose HIPAA protection
The notice warns that protected health information (PHI) disclosed as permitted by HIPAA may be redisclosed by the recipient and no longer 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 HIPAA permits.
Legal Rights & Agreement Rules · Restriction or exception
Special state or federal protections may apply to certain sensitive information
The notice says 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. It lists categories such laws may protect: 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.
Supporting quotations
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:
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
Qualifications & exceptions
Stated as "may"; whether a law applies depends on the law and the situation.
Not stated here
The notice does not name the specific laws or describe the protections.
Legal Rights & Agreement Rules · Company commitment
Aetna follows the stricter law where it applies; contact the Privacy Office for details
Aetna says it will follow the law that is stricter, meaning more protective of your PHI, where it applies to it. For more information about extra use or disclosure restrictions that may apply to your sensitive PHI, you can contact the Aetna Privacy Office.
Supporting quotations
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.
Qualifications & exceptions
Applies "where it applies to us."
Not stated here
The notice gives no contact details in this passage for the Privacy Office; an email address appears elsewhere in the notice.
Federal privacy rules give members several rights over their health information
The notice's rights section begins by saying the federal privacy regulations give you several rights regarding your health information.
Supporting quotations
Your Legal Rights
The federal privacy regulations give you several rights regarding your health information
Qualifications & exceptions
Introduces the rights listed in the cards that follow.
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.
Legal Rights & Agreement Rules · Restriction or exception
Will not use that information in a legal case against you without consent or a court order
Aetna says it will not use or share information that comes from a substance use disorder program in any legal case against you unless you give written consent, or a court orders it 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
Two routes are listed: your written consent, or a court order with a subpoena or other legal requirement.
Not stated here
It is not stated whether the notice-and-hearing sentence applies to both routes or only to the court-order route.
You can ask Aetna to communicate with you in a certain way or at a certain location
You have the right to ask Aetna to communicate with you in a certain way or at a certain location. For example, an adult dependent might want Explanation of Benefits forms and other claim information sent to a different address than the subscriber's. Aetna says it will accommodate reasonable requests. Elsewhere the notice says these forms are otherwise mailed to the address on record for the subscriber.
Supporting quotations
You have the right to ask us to communicate with you in a certain way or at a certain location. For example, if you are covered as an adult dependent, you might want us to send health information (e.g. Explanation of benefits (EOB) and other claim information) to a different address from that of your subscriber. We will accommodate reasonable requests.
We also mail Explanation of Benefits forms and other information to the address we have on record for the subscriber (i.e., the primary insured).
Qualifications & exceptions
Only "reasonable" requests are promised to be accommodated.
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 ask for a copy of your designated record set; it may need to be in writing and may carry a fee
You have the right to ask Aetna to obtain a copy of health information in a "designated record set," meaning medical records and other records used in making enrollment, payment, claims adjudication, medical management and other decisions. Aetna may ask for the request in writing, may charge a reasonable fee for producing and mailing the copies and, in certain cases, may deny the request.
Supporting quotations
You have the right to ask us to obtain a copy of health information that is contained in a “designated record set” – medical records and other records maintained and used in making enrollment, payment, claims adjudication, medical management, and other decisions. We may ask you to make your request in writing, may charge a reasonable fee for producing and mailing the copies and, in certain cases, may deny the request.
Qualifications & exceptions
Writing, a reasonable fee and denial in certain cases are all stated as things Aetna "may" do.
Not stated here
The cases in which a request may be denied are not described.
Account & Service Control · User right or choice
You can ask Aetna to amend your designated record set, in writing with a reason
You have the right to ask Aetna to amend health information in a designated record set. The request must be in writing and must include the reason. If Aetna denies the request, you may file a written statement of disagreement.
Supporting quotations
You have the right to ask us to amend health information that is in a “designated record set.” Your request must be in writing and must include the reason for the request. If we deny the request, you may file a written statement of disagreement.
Qualifications & exceptions
The request must be in writing and must state a reason.
Sharing & Disclosure · User right or choice
You can ask for a list of certain disclosures; repeat requests within 12 months may carry a fee
You have the right to ask Aetna for a list of certain disclosures it has made about you, such as disclosures of health information to government agencies that license it. The request must be in writing. If you ask for such an accounting more than once in a 12-month period, Aetna may charge a reasonable fee.
Supporting quotations
You have the right to ask us to provide a list of certain disclosures we have made about you, such as disclosures of health information to government agencies that license us. Your request must be in writing. If you request such an accounting more than once in a 12-month period, we may charge a reasonable fee.
Qualifications & exceptions
Covers "certain" disclosures; the written request is required; a fee may apply only after more than one request in 12 months.
Not stated here
The notice does not say which disclosures are included or excluded.
Security & Safeguards · User right or choice
You have the right to be notified of a breach involving your health information
The notice says you have the right to be notified following a breach involving your health information.
Supporting quotations
You have the right to be notified following a breach involving your health information.
Not stated here
The notice does not say how soon or by what method notice is given.
Use & Processing · User right or choice
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.
Data Access & Collection · User right or choice
You have the right, with very limited exceptions, not to be subjected to pretext interviews
The notice says you have the right, with very limited exceptions, not to be subjected to pretext interviews. A footnote marker follows this sentence; the footnote is carried in a separate card.
Supporting quotations
You have the right with very limited exceptions, not to be subjected to pretext interviews.
Qualifications & exceptions
Stated with "very limited exceptions."
Not stated here
The exceptions are not described.
Account & Service Control · Procedure
Requests, a paper copy and questions can be made by calling 1-800-264-4000
The notice says you may make any of the requests described above, request a paper copy of this notice, or ask questions about it by calling the toll-free number 1-800-264-4000. Some listed rights also say the request must or may need to be in writing.
Supporting quotations
You may make any of the requests described above, may request a paper copy of this notice, or ask questions regarding this notice by calling toll-free 1-800-264-4000.
Qualifications & exceptions
Read alongside the rights that call for written requests.
Not stated here
The notice does not reconcile the phone option with the written-request wording in some rights.
Legal Rights & Agreement Rules · User right or choice
You can file a privacy complaint with Aetna or the federal health department without penalty
You have the right to file a complaint if you think your privacy rights have been violated. You can email the Aetna Privacy Office at PrivacyAetna@aetna.com or write to the HIPAA Member Rights Team at the P.O. Box listed. You may also write to the Secretary of the U.S. Department of Health and Human Services. The notice says you will not be penalized for filing a complaint.
Supporting quotations
You also have the right to file a complaint if you think your privacy rights have been violated. To do so, please send an email to Aetna Privacy Office at PrivacyAetna@aetna.com or send your request to the following address:
HIPAA Member Rights Team P.O. Box 14079
Lexington, KY 40512-4079
You also may write to the Secretary of the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.
Qualifications & exceptions
Complaint routes are email, mail, or a written complaint to the federal health department Secretary.
Account & Service Control · Procedure
You can stop paper mailing of Explanation of Benefits forms by registering on the website
You can stop paper mailing of your Explanation of Benefits forms and other claim information by going to aetna.com, selecting Log In/Register, and completing the one-time registration. You can then log in any time to view past copies of EOBs and other claim information.
Supporting quotations
You may stop the paper mailing of your EOB and other claim information by visiting https://www.aetna.com/ and click “Log In/Register”. Follow the prompts to complete the one-time registration. Then you can log in any time to view past copies of EOBs and other claim information.
Legal Rights & Agreement Rules · Company commitment
Federal rules require Aetna to keep information private, give notice and follow this notice
Aetna says the federal privacy regulations require it to keep personal information about you private, to give you notice of its legal duties and privacy practices, and to follow the terms of the notice currently in effect.
Supporting quotations
Aetna’s Legal Obligations
The federal privacy regulations require us to keep personal information about you private, to give you notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.
Qualifications & exceptions
Tied to "the notice currently in effect," which the notice later says Aetna may change.
Security & Safeguards · Company commitment
Protects information with administrative, technical and physical safeguards
Aetna says it guards your information with administrative, technical and physical safeguards to protect it against unauthorized access and against threats and hazards to its security and integrity, and that it complies with all applicable state and federal law about the security and confidentiality of personal information.
Supporting quotations
Safeguarding Your Information
We guard your information with administrative, technical, and physical safeguards to protect it against unauthorized access and against threats and hazards to its security and integrity. We comply with all applicable state and federal law pertaining to the security and confidentiality of personal information.
Not stated here
The specific safeguards are not described.
Legal Rights & Agreement Rules · Permission or license
Aetna may change the notice and its policies at any time, applying to information it already holds
Aetna says it may change the terms of this notice and its privacy policies at any time. If it does, the new terms and policies will be effective for all of the information it already has about you, as well as any information it may receive or hold in the future.
Supporting quotations
This Notice is Subject to Change
We may change the terms of this notice and our privacy policies at any time. If we do, the new terms and policies will be effective for all of the information that we already have about you, as well as any information that we may receive or hold in the future.
Qualifications & exceptions
New terms apply retroactively to information already held, as well as future information.
Not stated here
The notice does not say how members will be told of a change.
Does not destroy personal information when coverage ends; may keep using it for the described purposes
Aetna says it does not destroy personal information about you when you terminate your coverage. It may be necessary to use and disclose the information for the purposes described in the notice even after coverage ends, although policies and procedures remain in place to protect against inappropriate use or disclosure.
Supporting quotations
How Aetna Uses and Discloses Personal Information
Please note that we do not destroy personal information about you when you terminate your coverage with us. It may be necessary to use and disclose this information for the purposes described above even after your coverage terminates, although policies and procedures will remain in place to protect against inappropriate use or disclosure.
Qualifications & exceptions
Continued use is for "the purposes described above" and is stated as something that "may be necessary."
Not stated here
No retention period or deletion process is stated.
Legal Rights & Agreement Rules · Context
Coverage may be underwritten or administered by several Aetna insurers; mail order pharmacy by Aetna Rx Home Delivery
The notice lists the companies that may underwrite or administer coverage, including Aetna Health Inc., Aetna Life Insurance Company, American Continental Insurance Company and Continental Life Insurance Company of Brentwood, Tennessee among others. It adds that mail order pharmacy services may be provided by Aetna Rx Home Delivery, LLC.
Supporting quotations
Coverage may be underwritten or administered by one or more of the following companies: Aetna Health Inc.; Aetna Health of California Inc.; Aetna Dental of California Inc.; Aetna Dental Inc.; Aetna Life Insurance Company; Aetna Insurance Company of Connecticut; Aetna Health Insurance Company of New York; American Continental Insurance Company; Continental Life Insurance Company of Brentwood, Tennessee and Corporate Health Insurance Company; Aetna Health and Life Insurance Company, Aetna Health Insurance Company, Coventry Health and Life Insurance Company, First Health Life and Health Insurance Company. Mail order pharmacy services may be provided by Aetna Rx Home Delivery, LLC.
Qualifications & exceptions
Coverage may be underwritten or administered by "one or more" of the listed companies.
Not stated here
The notice does not say which listed company applies to a particular member's plan.
Data Access & Collection · Company commitment
Footnote: Aetna does not participate in pretext interviews
Footnote 2 says Aetna does not participate in pretext interviews. It is attached to the right, in the member-rights section, not to be subjected to pretext interviews.
Supporting quotations
2 We do not participate in pretext interviews.
Qualifications & exceptions
Attached to the pretext-interview right by the footnote marker "2."
Covers Aetna's insured plans, not employer self-funded plans
This notice applies to Aetna's insured health benefit plans. It does not apply to plans that an employer self-funds. For a group health insurance plan, the employer can say whether the plan is insured or self-funded, and a member in a self-funded plan may want to ask the employer for its own privacy notice. The notice describes how medical information about you may be used and disclosed and how you can get access to it.
Supporting quotations
This Notice of Privacy Practices applies to Aetna’s insured health benefit plans. It does not apply to any plans that are self-funded by an employer.
If your plan is self-funded, you may want to ask for a copy of your employer’s privacy 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
Applies to insured plans only; plans self-funded by an employer are excluded.
The employer, not this notice, tells a group member whether the plan is insured or self-funded.
Not stated here
The notice does not say which individual plans are insured or self-funded.
Legal Rights & Agreement Rules · Procedure
Spanish version available by calling Member Services
The notice says, in Spanish, that to receive it in Spanish a member should call the toll-free Member Services number shown on their ID card.
Supporting quotations
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.
Qualifications & exceptions
The number is on the member ID card, not in this document.
Not stated here
The Member Services phone number is not given in the notice.
Legal Rights & Agreement Rules · Company commitment
Treats personal information as confidential under law and company policy
Aetna says it considers personal information confidential and protects its privacy in accordance with federal and state privacy laws and its own company privacy policies. The notice describes how Aetna may use and disclose information in administering your benefits and explains your legal rights about that information.
Supporting quotations
Aetna1 considers personal information confidential. We protect the privacy of that information in accordance with federal and state privacy laws, as well as our own company privacy policies.
This notice describes how we may use and disclose information about you in administering your benefits, and it explains your legal rights regarding the information.
Qualifications & exceptions
Stated as a general commitment; the specific uses and disclosures are in the sections that follow.
Not stated here
The company privacy policies it refers to are not part of this document.
Legal Rights & Agreement Rules · Context
Defines "personal information" and "health information"
In this notice, "personal information" means information that identifies you, such as your name and Social Security Number, plus financial, health and other nonpublic information Aetna obtains so it can provide you with insurance coverage. "Health information" means information that identifies you and relates to your medical history, meaning the health care you receive or the amounts paid for it.
Supporting quotations
we mean information that identifies you as an individual, such as your name and Social Security Number, as well as financial, health and other information about you that is nonpublic, and that we obtain so we can provide you with insurance coverage
we mean information that identifies you and relates to your medical history (i.e., the health care you receive or the amounts paid for that care)
Qualifications & exceptions
The personal-information definition is limited to nonpublic information obtained to provide insurance coverage.
"Aetna" and "we" mean the HMO and insurer subsidiaries that share information as one covered entity
A footnote says that in this notice "Aetna," "we," "us" and "our" refer to all of the HMO and licensed insurer subsidiaries of Aetna Inc. These entities are designated a single affiliated covered entity for federal privacy purposes, and its members can share protected health information (PHI) with each other for the treatment, payment and health care operations of that group and as HIPAA and the notice allow. A full list of members is available from the Aetna Privacy Office at PrivacyAetna@aetna.com.
Supporting quotations
“Aetna” and the pronouns “we,” “us” and “our” refer to all of the HMO and licensed insurer subsidiaries of Aetna
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.
Qualifications & exceptions
Sharing inside the group is for treatment, payment and health care operations of the group and as HIPAA and the notice allow.
The sentence is split across two source blocks by a page break ("Aetna" / "Inc.").
Not stated here
The notice does not list the member entities; it points to the Privacy Office for the list.
Legal Rights & Agreement Rules · Context
Notice became effective October 1, 2025
The notice says it became effective on October 1, 2025. The page header and footer carry the form identifier "GR-68737 (2-26) ACIC"; the notice does not explain how that identifier relates to the stated effective date.
Supporting quotations
This notice became effective on October 1, 2025.
GR-68737 (2-26) ACIC
Qualifications & exceptions
The stated effective date is the October 1, 2025 date in the text.
Not stated here
The meaning of "(2-26)" in the form identifier is not explained.
Data Access & Collection · Company practice
Obtains personal information from you, employers, insurers, administrators and providers
To provide insurance coverage Aetna says it needs personal information about you, and it obtains that information from many sources, particularly you, your employer or benefits plan sponsor if applicable, other insurers, HMOs, or third-party administrators (TPAs), and health care providers.
Supporting quotations
we need personal information about you, and we obtain that information from many different sources – particularly you, your employer or benefits plan sponsor if applicable, other insurers, HMOs, or third-party administrators (TPAs), and health care providers.
Qualifications & exceptions
"Particularly" signals the listed sources are the main ones, not necessarily a complete list.
Employer or plan sponsor applies "if applicable."
Not stated here
Other possible sources are not named.
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.
Sharing & Disclosure · Permission or license
Information may be used to facilitate a sale, merger or consolidation, including due diligence
One listed operational activity is facilitating a sale, transfer, merger or consolidation of all or part of Aetna with another entity, including due diligence related to that activity. The notice treats this as a use and disclosure of personal information within health care operations.
Supporting quotations
facilitation of a sale, transfer, merger or consolidation of all or part of Aetna with another entity (including due diligence related to such activity)
Qualifications & exceptions
Listed among health care operations activities.
Not stated here
The notice does not say what information is disclosed or to whom in such a transaction.
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.
Sharing & Disclosure · Company practice
Explanation of Benefits forms are mailed to the subscriber's address on record
Aetna says it mails Explanation of Benefits forms and other information to the address it has on record for the subscriber, meaning the primary insured. The subscriber can be a different person from the member, such as the primary insured for an adult dependent. Elsewhere the notice describes a right to request communications at a different address and a way to stop paper mailing.
Supporting quotations
We also mail Explanation of Benefits forms and other information to the address we have on record for the subscriber (i.e., the primary insured).
Qualifications & exceptions
The address used is the subscriber's, not necessarily the member's.
Sharing & Disclosure · Permission or license
May disclose information to health care providers who treat you
Aetna may disclose information to doctors, dentists, pharmacies, hospitals and other health care providers who take care of you. For example, doctors may request medical information from Aetna to supplement their own records. Aetna also may use personal information in providing mail order pharmacy services and in sending certain information to doctors for patient safety or other treatment-related reasons.
Supporting quotations
In administering your health benefits we may use and disclose personal information about you in various ways, including:
Treatment: We may disclose information to doctors, dentists, pharmacies, hospitals, and other health care providers who take care of you.
For example, doctors may request medical information from us to supplement their own records. We also may use personal information in providing mail order pharmacy services and by sending certain information to doctors for patient safety or other treatment-related reasons.
Qualifications & exceptions
Stated as "may"; recipients are providers who take care of you.
Sharing & Disclosure · Permission or license
May disclose information to other covered entities and their business associates
Aetna may disclose personal information to other covered entities, or business associates of those entities, for treatment, payment and certain health care operations purposes. For example, for a group health insurance plan, it may disclose personal information to other health plans maintained by your employer if arranged, so that certain expenses can be reimbursed.
Supporting quotations
In administering your health benefits we may use and disclose personal information about you in various ways, including:
Disclosures to Other Covered Entities: We may disclose personal information to other covered entities, or business associates of those entities for treatment, payment and certain health care operations purposes.
For example, if you receive benefits through a group health insurance plan, we may disclose personal information to other health plans maintained by your employer if it has been arranged for us to do so in order to have certain expenses reimbursed.
Qualifications & exceptions
Purposes are limited to treatment, payment and "certain" health care operations.
The employer-plan example applies to group health insurance plans and only if arranged.
Not stated here
The notice does not say which health care operations purposes are covered by "certain."