Examples of uses: transfer of policies and due diligence for sale or transfer of Benefits Plans
A further example of the uses in Section V is the transfer of policies or contracts from and to other insurers or third party administrators. Aetna also lists facilitating due diligence activities connected with the purchase, sale or transfer of Benefits Plans. These activities can involve NPI moving to other insurers, administrators and parties to a sale or transfer.
Supporting quotations
Transfer of policies or contracts from and to other insurers or third party administrators; and facilitation of due diligence activities in connection with the purchase, sale or transfer of Benefits Plans.
Qualifications & exceptions
Listed as one of the Section V examples.
Not stated here
The notice does not say what NPI is shared in due diligence, with whom, or under what confidentiality terms.
Sharing & Disclosure · Permission or license
Aetna may disclose NPI to affiliated entities or nonaffiliated third parties as otherwise permitted by law
In addition to the Section V examples, Aetna says it may disclose NPI to affiliated entities or nonaffiliated third parties as otherwise permitted by law. The sentence names no purpose or category of recipient beyond “permitted by law,” so it works as a general permission alongside the specific lists.
Supporting quotations
In addition, we may disclose NPI to affiliated entities or nonaffiliated third parties as otherwise permitted by law.
Qualifications & exceptions
The only stated limit is “as otherwise permitted by law.”
Not stated here
The notice does not say which laws apply or what kinds of third parties this covers.
Sharing & Disclosure · Company commitment
Aetna says it seeks special authorization before disclosing NPI for other purposes
For purposes other than those in Section V, Aetna says it seeks special authorization before disclosing the information. The wording is “seeks,” not “requires,” and it is set alongside the statement that Aetna may also disclose NPI as otherwise permitted by law.
Supporting quotations
For other purposes, we seek special authorization before disclosing the information.
Qualifications & exceptions
“Other purposes” means purposes other than those described in Section V and the disclosures otherwise permitted by law.
Not stated here
The notice does not say what happens if authorization is not obtained for a purpose that is otherwise permitted by law.
Sharing & Disclosure · Company commitment
Aetna says it seeks special authorization before disclosing NPI for marketing unrelated to the plans
Aetna says it recognizes that many members do not want unsolicited marketing materials unrelated to their Benefit Plans, so it seeks special authorization before disclosing NPI for these marketing purposes. Marketing that educates employees about their own benefits is described separately as part of the Section V activities that go ahead regardless of preferences.
Supporting quotations
Of course, we recognize that many members do not want to receive unsolicited marketing materials unrelated to their Benefit Plans. Therefore, we seek special authorization before disclosing NPI for these marketing purposes.
target marketing helps us to better educate employees about the benefits available to them.
Qualifications & exceptions
The commitment is to “seek” authorization, not to require it, and covers disclosure of NPI for marketing unrelated to the Benefit Plans.
Plan-related “target marketing” is within the Section V activities and does not need this authorization.
Not stated here
The notice does not say what counts as marketing “unrelated” to the plans.
It does not address whether Aetna uses NPI internally for unrelated marketing without disclosing it.
Other disclosures: call for a special authorization form and mail it to the HIPAA Member Rights Team
To have Aetna disclose personal information to a person or organization, or for reasons other than those in Section V, the member calls the toll-free customer service number to ask for a special authorization form. The notice’s example is making records available to a neighbor who is helping resolve a claim question. The member fills out the form and sends it to the HIPAA Member Rights Team at P.O. Box 14079, Lexington, KY 40512-4079.
Supporting quotations
Many people ask us to disclose NPI to third parties or for reasons not described in Section V. For example, you may want us to make your records available to a neighbor who is helping you resolve a question about your claim. To authorize us to disclose any of your personal information to a person or organization or for reasons other than those described in Section V above, please call our toll-free customer service phone number listed in Section I to ask for a special authorization form. When you receive the form, fill it out and send it to us at the following address:
HIPAA Member Rights Team P.O. Box 14079 Lexington, KY 40512-4079
*Life and Disability toll free number: 1-866-825-6944
Qualifications & exceptions
The route described is by phone request and then mailing the completed form.
Not stated here
The notice does not say how long processing takes or whether the form can be obtained online.
Sharing & Disclosure · User right or choice
A member can revoke a special authorization by letter to the same address
A member who changes their mind about a special authorization can send a letter to the HIPAA Member Rights Team address saying they want to revoke it. The letter should include name, address, member identification number or Social Security number, and a telephone number where Aetna can reach the member to confirm the request.
Supporting quotations
If you fill out a form and later change your mind about the special authorization, send a letter to us at the same address, letting us know that you would like to revoke the special authorization. Please provide your name, address, member identification number or Social Security number, and a telephone number where we can reach you to confirm your request.
Qualifications & exceptions
The notice describes revoking by letter; no other way is mentioned.
The member supplies a member ID or Social Security number and a phone number for confirmation.
Not stated here
The notice does not say when revocation takes effect or whether it affects disclosures already made.
Aetna does not disclose NPI except with member authorization or as permitted by law
Under the Section V heading about what information Aetna and other benefits plans use or disclose to third parties, Aetna says it does not disclose NPI to anyone, except with member authorization (Section VII) or otherwise as permitted by law. It says disclosures permitted by law typically include those described in more detail in Section V. The authorization route is a special authorization form requested through the toll-free number. The exception for disclosures “permitted by law” is wide: later sections say Aetna uses and discloses NPI as described in Section V regardless of individual preferences to the extent permitted by law, and may disclose NPI to affiliated entities or nonaffiliated third parties as otherwise permitted by law.
Supporting quotations
V. What personal information does Aetna and other benefits plans use or disclose to third parties, and for what purposes?
We do not disclose NPI to anyone, except with member authorization (see Section VII) or otherwise as permitted by law. Disclosures permitted by law typically include those described in more detail below.
To authorize us to disclose any of your personal information to a person or organization or for reasons other than those described in Section V above, please call our toll-free customer service phone number listed in Section I to ask for a special authorization form.
Qualifications & exceptions
Two exceptions: member authorization and disclosure otherwise permitted by law.
Later sections add that the Section V uses and disclosures occur “regardless of individual preferences” to the extent permitted by law, and that authorization is sought for other purposes.
Not stated here
The notice does not cite which laws make disclosures permitted.
The Section V heading refers to “Aetna and other benefits plans”; the notice does not say which other benefits plans are meant.
Sharing & Disclosure · Permission or license
NPI is used internally and shared with affiliates, providers, insurers, payors, vendors and government authorities
Aetna says that when necessary for the operation of its Benefits Plans, or other related activities, it uses NPI internally, shares it with its affiliates, and discloses it to health care providers (doctors and other caregivers), other insurers, third party administrators, payors, vendors, consultants, government authorities, and their respective agents. “Payors” are described as employers who sponsor self-funded Benefits Plans and others who may be financially responsible for payment for the services or benefits under the plan.
Supporting quotations
When necessary for the operation of our Benefits Plans, or other related activities, we use NPI internally, share it with our affiliates, and disclose it to health care providers (doctors and other caregivers), other insurers, third party administrators, payors (employers who sponsor self-funded Benefits Plans and others who may be financially responsible for payment for the services or benefits you receive under your plan), vendors, consultants, government authorities, and their respective agents.
Qualifications & exceptions
The condition is “when necessary for the operation of our Benefits Plans, or other related activities.”
Payors include employers who sponsor self-funded plans, so some NPI can be disclosed to an employer in that role.
The list names the recipients; it does not say which recipients receive which kinds of NPI.
Not stated here
“Other related activities” is not defined.
“Affiliates” is not defined here and is separate from the defined term “Aetna.”
The notice does not say how “necessary” is decided.
Sharing & Disclosure · Restriction or exception
Recipients are described as required to keep NPI confidential as provided by applicable law
After listing the recipients of NPI, the notice says these parties are required to keep NPI confidential as provided by applicable law. The statement ties the confidentiality duty to applicable law rather than describing a contract term Aetna imposes.
Supporting quotations
These parties are required to keep NPI confidential as provided by applicable law.
Qualifications & exceptions
The duty is “as provided by applicable law.”
Not stated here
The notice does not say which laws apply or whether every listed recipient, such as an employer acting as payor or a government authority, is bound in the same way.