Long-term care plans notice of privacy practices

Legal Rights & Agreement Rules · Context

Notice covers Aetna's long term care plans

This is the privacy notice for Aetna's long term care plans. It says it describes how Aetna may use and disclose information about you while administering your benefits, and it explains your legal rights about that information. The page heading says the notice covers 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 long term care plans.

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.

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

Qualifications & exceptions

• The notice is stated to apply to long term care plans only; it does not name individual policy forms or products.

Not stated here

• The source does not list which specific long term care policies or plan sponsors are covered beyond the plan-type name.

Account & Service Control · Procedure

Spanish copy available through Member Services

A Spanish-language line says that to receive this notice in Spanish you should call the toll-free Member Services (Servicios a Miembros) number printed on your ID card. The notice itself, as saved, is in English.

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 to call is the one on the member ID card, not a number given in this notice.

Not stated here

• The Member Services number and its hours are not stated in the notice.

Security & Safeguards · Company commitment

Aetna treats personal information as confidential

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. A later section adds that the federal privacy regulations require Aetna to keep your personal information 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

Aetna1 considers personal information to be confidential.

We protect the privacy of that information in accordance with federal and state privacy laws, as well as our own company privacy policies.

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.

Aetna’s Legal Obligations

Qualifications & exceptions

• The protection is described as being 'in accordance with' federal and state privacy laws and Aetna's own policies, so it does not promise more than those laws and policies require.
• The notice may be changed by Aetna (see the change-of-notice section).

Not stated here

• Aetna's company privacy policies are referred to but not supplied or linked in this notice.
• The specific state laws that apply are not named.

Data Access & Collection · Context

What 'personal information' and 'health information' mean

In this notice, 'personal information' means nonpublic 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 Aetna obtains so it can provide you with insurance coverage. 'Health information' means information that identifies you and relates to your medical history, for example the health care you receive or the amounts paid for that care.

Supporting quotations

When we use the term “personal information,” 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.

By “health information,” we mean information that identifies you and relates to your medical history (e.g., the health care you receive or the amounts paid for that care).

Qualifications & exceptions

• The examples ('such as', 'e.g.') are illustrations, not a closed list.
• Personal information is limited to nonpublic information obtained so Aetna can provide insurance coverage.

Not stated here

• Later text also uses 'Protected Health Information (PHI)'; the notice does not define PHI separately, so whether it matches 'health information' is not stated.

Legal Rights & Agreement Rules · Context

Notice effective October 1, 2025

The notice states that it became effective on October 1, 2025. The page header of the saved copy carries the form code 'GR-67969 (2-26)'.

Supporting quotations

This notice became effective on October 1, 2025.

GR-67969 (2-26) Page 1 of 5

Qualifications & exceptions

• Aetna may change the notice later; see the change-of-notice section.

Not stated here

• The source does not explain what '(2-26)' in the form code means or whether it differs from the stated effective date.

Data Access & Collection · Company practice

Where Aetna gets your personal information

To provide insurance coverage, Aetna says it needs personal information about you and obtains it from many different sources, particularly your employer or benefits plan sponsor, other insurers, HMOs or third-party administrators (TPAs), and health care providers.

Supporting quotations

In order to provide you with insurance coverage, we need personal information about you, and we obtain that information from many different sources – particularly your employer or benefits plan sponsor, other insurers, HMOs or Third Party Administrator (TPAs), and health care providers.

Qualifications & exceptions

• 'Many different sources' and 'particularly' mean the named sources are examples, not the full list.

Not stated here

• Other sources are not named in this section.

Use & Processing · Permission or license

Aetna may use and disclose your information in various ways

In administering your health benefits, Aetna says it may use and disclose your personal information in various ways, 'including' health care operations, payment, treatment and disclosures to other covered entities (the cards that follow). These are permissions, not duties. They are qualified elsewhere in the notice. Aetna may also disclose health information to a relative, friend or other person you identify, but only information directly relevant to that person's involvement with your care or payment for it, and you can stop or limit that by calling the toll-free hotline. Information that comes from a substance use disorder program with a 42 CFR Part 2 consent is used or shared in accordance with both that consent and HIPAA. Some state and federal laws may add special protections for certain sensitive health information (see the section on additional restrictions).

Supporting quotations

In administering your health benefits, we may use and disclose this information in various ways, including:

We may disclose health information about you to a relative, a friend, 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.

You have the right to stop or limit this kind of disclosure by calling our toll-free hotline at 1-800-537-8521.

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.

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.

Disclosure to Others Involved in Your Health Care

Additional Restrictions on Use and Disclosure

Substance Use Disorder Information

Qualifications & exceptions

• 'May' and 'including' make the list permissive and non-exhaustive here; the notice has further sections on additional reasons for disclosure, required disclosures and disclosures needing your written authorization.
• Disclosure to people involved in your care is limited to information directly relevant to that person's involvement.
• You have the right to stop or limit disclosures to people involved in your care.
• Some state and federal laws may add special protections for certain sensitive health information, as described in the additional-restrictions section.

Not stated here

• The notice does not say which state laws apply or how requestor attestations work in practice.

Cross-references

• qualified by (model-proposed): Written authorization for uses not described in the notice — Written authorization is required for situations other than those the notice describes, which bounds the general permissions to use and disclose information.
• qualified by (model-proposed): Extra protections for certain sensitive information — Special state and federal protections for sensitive health information limit the general permissions to use and disclose information.
• qualified by (model-proposed): How information from substance use disorder programs is handled — Information from substance use disorder programs received under a Part 2 consent is used or shared in accordance with both the consent and HIPAA, which qualifies the general treatment, payment and operations permissions.

Use & Processing · Permission or license

Use and disclosure for Aetna's health care operations

Aetna may use and disclose personal information while running its health business: quality assessment and improvement, performance measurement and outcomes assessment, health services research, and disease management, case management and care coordination. For example, it may use information to run disease management programs for members with specific conditions such as diabetes, asthma or heart failure. Other operational activities that need use and disclosure include administering reinsurance and stop loss, underwriting and rating, detecting and investigating fraud, transferring policies or contracts to or from other health plans, and other general administrative activities such as data and information systems management and customer service.

Supporting quotations

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; performance measurement and outcomes assessment; health services research; and 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.

Other operational activities requiring use and disclosure include administration of reinsurance and stop loss; underwriting and rating; detection and investigation of fraud; transfer of policies or contracts from and to other health plans;

Qualifications & exceptions

• 'May' makes this a permission, not a duty.
• 'Other operational activities' and 'other general administrative activities' leave the list open.
• Underwriting is listed as an operations use; the notice separately gives you the right to know the reasons for an unfavorable underwriting decision (see Your Legal Rights).

Not stated here

• The notice does not say how much information is used for each purpose or which parties receive it for research.

Cross-references

• qualified by (model-proposed): Right to know reasons for an unfavorable underwriting decision — Underwriting is listed as a health care operation; the rights section gives members the right to know the reasons for an unfavorable underwriting decision and limits reliance on earlier unfavorable decisions.

Sharing & Disclosure · Permission or license

Information may be used in a sale or merger of Aetna

Among the health care operations listed, Aetna may use and disclose personal information to help carry out a sale, transfer, merger or consolidation of all or part of Aetna with another entity, including due diligence related to that activity.

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

• It is listed under health care operations and is stated as something that may happen, not something that will.
• It covers all or part of Aetna.

Not stated here

• The notice does not say what protections or restrictions bind the other entity that receives information in such a transaction.

Use & Processing · Permission or license

Use and disclosure to pay for covered services

To help pay for your covered services, Aetna may use and disclose personal information in conducting utilization and medical necessity reviews, coordinating care, determining eligibility, collecting premiums, 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 you have suffered a loss of functional capacity, and may disclose information to your provider during that process.

Supporting quotations

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; collecting premiums; 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 determine if you have suffered a loss of functional capacity – and during the process, we may disclose information to your provider.

Qualifications & exceptions

• 'May' makes this a permission; 'in a number of ways' means the listed purposes are examples.

Not stated here

• The notice does not say what 'loss of functional capacity' means for a particular plan.

Account & Service Control · Company practice

Benefit notices and EOBs go to the member's address on record

Aetna mails notices of benefit determination, Explanation of Benefits forms and other information to the address it has on record for the member. Elsewhere the notice describes ways to ask for a different location or method, and to stop paper mailing (see Your Legal Rights).

Supporting quotations

We also mail notices of benefit determination, Explanation of Benefits forms and other information to the address we have on record for the member.

Qualifications & exceptions

• The address on record is the default; the rights section describes how to ask for a different arrangement.

Not stated here

• The notice does not say how quickly a changed address or stopped paper mailing takes effect.

Cross-references

• qualified by (model-proposed): Right to ask for communications in a certain way or place — The right to ask for communications at a different place or by a different method qualifies the default of mailing benefit notices and EOBs to the address on record.
• qualified by (model-proposed): You can stop paper EOB mailing online — Members can stop paper mailing of EOBs and claim information by registering online, which qualifies the default practice of mailing them.

Sharing & Disclosure · Permission or license

Disclosure to providers who care for you

Aetna may disclose information to doctors, 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, and Aetna may send certain information to doctors for patient safety or other treatment-related reasons.

Supporting quotations

Treatment: We may disclose information to doctors, hospitals and other health care providers who take care of you.

We also may send certain information to doctors for patient safety or other treatment-related reasons.

Qualifications & exceptions

• Limited to providers who take care of you; 'may' makes it permissive.
• 'Other treatment-related reasons' is open-ended.

Not stated here

• The notice does not say which information is sent for patient safety reasons.

Sharing & Disclosure · Permission or license

Disclosure to other covered entities and their business associates

Aetna may disclose personal information to other covered entities, or to business associates of those entities, for treatment, payment and certain health care operations purposes. For example, it may disclose information to government entities, if it has been arranged for it to do so, to help determine eligibility for state or federal benefit programs such as Medicaid.

Supporting quotations

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, we may disclose information to government entities, if it has been arranged for us to do so, in order to assist in determining eligibility for state or federal benefit programs such as Medicaid.

Qualifications & exceptions

• Limited to treatment, payment and 'certain' health care operations purposes.
• The government example applies only if it has been arranged for Aetna to do so.

Not stated here

• The notice does not say which health care operations purposes count as 'certain' ones.

Sharing & Disclosure · Permission or license

'Aetna' means a group of affiliated entities that can share information

For this notice, 'Aetna' and 'we', 'us' and 'our' refer to all of the HMO and licensed insurer subsidiaries of Aetna Inc. These entities are designated as a single affiliated covered entity (the Aetna ACE) for federal privacy purposes. Members of the ACE can share Protected Health Information (PHI) with each other for the treatment, payment and health care operations of the ACE and as allowed by HIPAA and this notice. The full list of members is available by contacting the Aetna Privacy Office at PrivacyAetna@aetna.com.

Supporting quotations

For purposes of this notice, “Aetna” and the pronouns “we,” “us” and “our” refer to all of the HMO and licensed insurer subsidiaries of Aetna

Inc. These entities have been designated as a single affiliated covered entity for federal privacy purposes. The members of the Aetna ACE can share Protected Health Information (PHI) with each other. We do this for the treatment, payment and health care operations of the Aetna ACE and as allowed by HIPAA and this Notice.

For a full list of the members of the Aetna ACE, contact the Aetna Privacy Office at PrivacyAetna@aetna.com.

Qualifications & exceptions

• The sharing among ACE members is limited to treatment, payment and health care operations of the ACE and what HIPAA and the notice allow.
• The definition applies to HMO and licensed insurer subsidiaries, not to every Aetna Inc. affiliate.

Not stated here

• The notice does not list the ACE members; the list must be requested from the Aetna Privacy Office.

Use & Processing · Permission or license

Use for treatment alternatives, reminders and health-related benefits

Aetna may use or disclose personal information about you to provide treatment alternatives, treatment reminders, or other health-related benefits and services.

Supporting quotations

We may use or disclose personal information about you in providing you with treatment alternatives, treatment reminders, or other health-related benefits and services.

Qualifications & exceptions

• 'May' makes this a permission.
• 'Other health-related benefits and services' is open-ended.
• Marketing that is unrelated to your benefit plan(s) is treated differently: the notice says Aetna will ask for your written authorization for it.

Not stated here

• The notice does not say how Aetna decides which services count as health-related benefits rather than marketing.

Sharing & Disclosure · Permission or license

Disclosure to researchers

Aetna may disclose personal information in support of research, to researchers, provided measures are taken to protect your privacy. This is listed as one of the additional reasons for disclosure, separate from the health services research that the notice lists as a health care operation.

Supporting quotations

Research – to researchers, provided measures are taken to protect your privacy.

We also may disclose such information in support of:

Qualifications & exceptions

• The condition is that measures are taken to protect your privacy.
• 'May' makes this a permission; the section lists it among reasons Aetna may disclose information without asking for authorization.

Not stated here

• The notice does not say what privacy measures are taken, who the researchers are, or whether information is de-identified.

Sharing & Disclosure · Permission or license

Disclosure to business partners who provide services

Aetna may disclose personal information to persons who provide services to it and assure it they will protect the information.

Supporting quotations

Business Partners – to persons who provide services to us and assure us they will protect the information.

Qualifications & exceptions

• Recipients are limited to persons who provide services to Aetna and who assure Aetna they will protect the information.

Not stated here

• The notice does not say which kinds of service providers receive information, what the assurance consists of, or how it is enforced.

Legal Rights & Agreement Rules · Permission or license

Disclosure to regulators and for workers' compensation

Aetna may disclose information to state insurance departments, the U.S. Department of Labor and other government agencies that regulate it. It may also disclose information to comply with workers' compensation laws.

Supporting quotations

Industry Regulation – to state insurance departments, U.S. Department of Labor and other government agencies that regulate us.

Workers’ Compensation – to comply with workers’ compensation laws.

Qualifications & exceptions

• Regulator disclosures go to agencies that regulate Aetna.
• Workers' compensation disclosures are for complying with those laws.

Not stated here

• The notice does not say how much information is disclosed to regulators or whether limits apply.

Legal Rights & Agreement Rules · Permission or license

Disclosure to law enforcement, in legal proceedings and as required by law

Aetna may disclose information to federal, state and local law enforcement officials, in response to a court order or other lawful process, and to comply with legal obligations and requirements.

Supporting quotations

Law Enforcement – to federal, state and local law enforcement officials.

Legal Proceedings – in response to a court order or other lawful process.

As Required by Law – to comply with legal obligations and requirements.

Qualifications & exceptions

• Legal proceedings disclosures are tied to a court order or other lawful process.
• The 'as required by law' item is tied to legal obligations and requirements.
• The law enforcement item names the recipients but states no further condition in this section.

Not stated here

• The notice does not say what Aetna requires from law enforcement officials before disclosing, or whether a court order is needed for that item.

Legal Rights & Agreement Rules · Permission or license

Disclosure for matters of public interest

Aetna may disclose information to address matters of public interest as required or permitted by law, for example child abuse and neglect, threats to public health and safety, and national security.

Supporting quotations

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

• The disclosure must be as required or permitted by law.
• The examples are illustrations ('e.g.'), not a complete list.

Not stated here

• The notice does not say which laws govern these disclosures or what information is shared.

Sharing & Disclosure · Permission or license

Disclosure about deceased persons and for organ donation

Aetna may disclose information to a coroner or medical examiner to identify a deceased person, determine a cause of death, or as authorized by law, and to 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 director disclosures are limited to what is necessary to carry out their duties.
• Organ procurement disclosures are for facilitating donation and transplantation.

Legal Rights & Agreement Rules · Company commitment

Disclosures Aetna must make

Aetna says it must use and disclose your personal information in two ways: to you or to someone who has the legal right to act for you (your personal representative), in order to administer your rights described in 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

• Disclosure to the HHS Secretary is limited to what is necessary for HIPAA compliance and enforcement.
• Disclosure to you or your personal representative is to administer your rights in the notice.

Sharing & Disclosure · Permission or license

Disclosure to a relative, friend or caregiver

Aetna may disclose health information to a relative, a friend, 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. You have the right to stop or limit this kind of disclosure by calling the toll-free hotline, 1-800-537-8521.

Supporting quotations

We may disclose health information about you to a relative, a friend, 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.

You have the right to stop or limit this kind of disclosure by calling our toll-free hotline at 1-800-537-8521.

Qualifications & exceptions

• Limited to information directly relevant to the person's involvement with your care or payment.
• The example involves a caller with prior knowledge of a claim and only confirms receipt and payment.
• You can stop or limit the disclosure by calling the hotline.

Not stated here

• The notice does not say how Aetna verifies a caller's relationship to you.

Cross-references

• contrast (model-proposed): Right to ask Aetna to restrict uses and disclosures — This rights section words the right for disclosures to people involved in your care as a right to ask for a restriction that Aetna may not agree to, while the earlier section says you have the right to stop or limit that kind of disclosure by calling the hotline. The notice does not reconcile the two wordings.

Legal Rights & Agreement Rules · User right or choice

Minors may be able to block parental access

If you are a minor, you may have the right to block parental access to your health information in certain circumstances, if state law permits. You can contact Aetna through the toll-free hotline, 1-800-537-8521.

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 by calling our toll-free hotline at 1-800-537-8521.

Qualifications & exceptions

• 'May have' and 'in certain circumstances' mean the right is not unconditional.
• The right depends on state law permitting it.

Not stated here

• The notice does not say which circumstances or which states' laws apply.

Use & Processing · Company commitment

Written authorization for uses not described in the notice

For all situations other than those described above in the notice (health care operations, payment, treatment, disclosures to other covered entities, additional reasons for disclosure, required disclosures and disclosures to people involved in your care), Aetna says it will ask for your written authorization before using or disclosing personal information about you. Examples where it will get authorization: marketing purposes unrelated to your benefit plan(s), before disclosing any psychotherapy notes, the sale of your health information, and other reasons required by law.

Supporting quotations

In all situations other than those described above, we will ask for your written authorization before using or disclosing personal information about you.

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.

How Aetna Uses and Discloses Personal Information

Health Care Operations:

Payment:

Treatment:

Disclosures to Other Covered Entities:

Qualifications & exceptions

• The authorization rule applies only to situations 'other than those described above'; the described uses and disclosures do not require it.
• The examples are introduced by 'for example', so the list is not exhaustive.
• Marketing is listed only when unrelated to your benefit plan(s).

Not stated here

• The notice does not say whether marketing related to your benefit plan(s) needs authorization.

Cross-references

• qualifies (model-proposed): Aetna may use and disclose your information in various ways — Written authorization is required for situations other than those the notice describes, which bounds the general permissions to use and disclose information.

Use & Processing · User right or choice

You can revoke an authorization in writing

If you have given Aetna an authorization, you may revoke it in writing at any time, if Aetna has not already acted on it. For questions about authorizations you can call the toll-free hotline, 1-800-537-8521.

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 our toll-free hotline at 1-800-537-8521.

Qualifications & exceptions

• Revocation must be in writing.
• Revocation does not undo action Aetna has already taken on the authorization.

Not stated here

• The notice does not give a mailing address specifically for revocations; the address shown later is for complaints.

Sharing & Disclosure · Context

Recipients may redisclose information outside HIPAA protection

The notice warns that PHI disclosed as permitted by HIPAA 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

• The warning concerns PHI disclosed as permitted by HIPAA.
• 'May be subject to' means redisclosure is possible, not certain.

Not stated here

• The notice does not say which recipients are covered by HIPAA or what protections might still apply after redisclosure.

Legal Rights & Agreement Rules · Restriction or exception

Extra protections for certain sensitive information

Some state and federal laws may require special privacy protections, including requirements to obtain attestations from people who request information, that limit use and disclosure of certain sensitive health information. The notice says such laws may protect information about 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 on restrictions for 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.

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

• 'Some' and 'may' mean the notice does not say which laws apply or which categories are protected in a given state.
• The stricter-law commitment applies only 'where it applies to us'.
• These protections qualify the general permissions earlier in the notice.

Not stated here

• The notice does not name the laws or describe the specific protections for each category.
• The notice does not say how the attestation requirement works.

Cross-references

• qualifies (model-proposed): Aetna may use and disclose your information in various ways — Special state and federal protections for sensitive health information limit the general permissions to use and disclose information.

Use & Processing · Restriction or exception

How information from substance use disorder programs is handled

Aetna says it is not a substance use disorder treatment program, but it may receive or keep information about you that comes from one. If such a program gives Aetna 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 will use or share it in accordance with both the consent and HIPAA. In limited situations where Aetna may disclose it without your permission, such as medical emergencies and government audits, Aetna says it 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

• The rule covers information received through a 42 CFR Part 2 consent.
• The more-protective-law commitment applies to the 'limited situations' where disclosure without permission may occur; medical emergencies and government audits are examples.

Not stated here

• The notice does not say what the Part 2 consent covers beyond treatment, payment and health care operations, or how Aetna handles substance use disorder information that does not come through a Part 2 consent.

Cross-references

• qualifies (model-proposed): Aetna may use and disclose your information in various ways — Information from substance use disorder programs received under a Part 2 consent is used or shared in accordance with both the consent and HIPAA, which qualifies the general treatment, payment and operations permissions.

Legal Rights & Agreement Rules · Restriction or exception

Substance use disorder information not used in legal cases against you

Aetna says it will not use or share substance use disorder program information 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

• The two exceptions are written consent from you, or a court order with a subpoena or other legal requirement.
• The notice-and-hearing sentence is stated separately: 'You or Aetna must also receive notice and a chance to be heard.'

Not stated here

• The notice does not say whether the notice and chance to be heard apply to you, to Aetna, or to both in a given case.

Legal Rights & Agreement Rules · User right or choice

Federal rules give you several rights; requests go through the hotline

The notice says the federal privacy regulations give you several rights regarding your health information. You may make any of the requests described in the rights section, request a paper copy of the notice, or ask questions about it by calling the toll-free hotline, 1-800-537-8521.

Supporting quotations

The federal privacy regulations give you several rights regarding your health information.

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 our toll-free hotline at 1-800-537-8521.

Qualifications & exceptions

• Some requests must be in writing, as noted in the individual rights (for example copies, amendments and accountings).
• The hotline is the stated route for making requests and asking questions; the complaint route has its own address.

Not stated here

• The notice does not say how quickly Aetna responds to requests.

Account & Service Control · User right or choice

Right to ask for communications in a certain way or place

You have the right to ask Aetna 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 health information such as EOBs and other claim information sent to a different address from your subscriber's. Aetna says it will accommodate reasonable requests. This is an alternative to the default practice of mailing benefit notices and EOBs to the member's address on record.

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 notices of benefit determination, Explanation of Benefits forms and other information to the address we have on record for the member.

Qualifications & exceptions

• Aetna commits to accommodate only reasonable requests.
• The default is mailing to the address on record.

Not stated here

• The notice does not say what Aetna treats as an unreasonable request.

Cross-references

• qualifies (model-proposed): Benefit notices and EOBs go to the member's address on record — The right to ask for communications at a different place or by a different method qualifies the default of mailing benefit notices and EOBs to the address on record.

Account & Service Control · User right or choice

You can stop paper EOB mailing online

You may stop the paper mailing of your EOBs and other claim information by visiting www.aetna.com, selecting Log In/Register and completing a one-time registration. After that you can log in at 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 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.

Qualifications & exceptions

• Requires the one-time online registration at www.aetna.com.

Not stated here

• The notice does not say whether stopping paper mailing changes how other mailed notices are delivered.

Cross-references

• qualifies (model-proposed): Benefit notices and EOBs go to the member's address on record — Members can stop paper mailing of EOBs and claim information by registering online, which qualifies the default practice of mailing them.

Use & Processing · User right or choice

Right to ask Aetna to restrict uses and disclosures

You have the right to ask Aetna to restrict how it uses or discloses health information about you in connection with health care operations, payment and treatment (the uses described earlier in the notice, including disclosures to other covered entities). Aetna says it will consider such requests but may not agree to them. You also have the right to ask Aetna to restrict disclosures to persons involved in your health care.

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.

How Aetna Uses and Discloses Personal Information

Payment:

Disclosures to Other Covered Entities:

Disclosure to Others Involved in Your Health Care

You have the right to stop or limit this kind of disclosure by calling our toll-free hotline at 1-800-537-8521.

Qualifications & exceptions

• Aetna will consider but may not agree to restriction requests.
• The earlier section on others involved in your care says you have the right to stop or limit those disclosures by calling the hotline.

Not stated here

• This rights section words the right for people involved in your care as a right to ask; the earlier section words it as a right to stop or limit. The notice does not say whether Aetna can refuse a request for that kind of disclosure.

Cross-references

• contrast (model-proposed): Disclosure to a relative, friend or caregiver — This rights section words the right for disclosures to people involved in your care as a right to ask for a restriction that Aetna may not agree to, while the earlier section says you have the right to stop or limit that kind of disclosure by calling the hotline. The notice does not reconcile the two wordings.

Account & Service Control · User right or choice

Right to ask for a copy of your designated record set

You have the right to ask Aetna for a copy of health information in a 'designated record set', meaning records maintained and used in making enrollment, payment, claims adjudication, medical management and other decisions. Aetna may ask you to make 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” – 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

• Aetna may require the request in writing.
• Aetna may charge a reasonable fee for producing and mailing copies.
• Aetna may deny the request in certain cases.

Not stated here

• The notice does not say when a request may be denied, or what the fee is.

Account & Service Control · User right or choice

Right to ask Aetna to amend your records

You have the right to ask Aetna to amend health information in a designated record set. The request must be in writing and 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 include the reason.
• If denied, your remedy stated here is a written statement of disagreement.

Not stated here

• The notice does not say what happens to a statement of disagreement or when Aetna agrees to amend.

Account & Service Control · User right or choice

Right to a list of certain disclosures

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

• The list covers 'certain' disclosures, not every disclosure.
• The request must be in writing.
• A reasonable fee may apply after the first request in 12 months.

Not stated here

• The notice does not say which disclosures are excluded from the list.

Security & Safeguards · User right or choice

Right to be notified of a breach

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 or how quickly you will be notified, or what counts as a breach.

Use & Processing · User right or choice

Right to know reasons for an unfavorable underwriting decision

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. Underwriting is also listed earlier as a health care operation for which information may be used.

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.

Qualifications & exceptions

• A previous unfavorable decision can be a basis for a future one only if Aetna makes an independent evaluation of the basic facts.

Not stated here

• The notice does not say how to request the reasons or how long Aetna takes to provide them.

Cross-references

• qualifies (model-proposed): Use and disclosure for Aetna's health care operations — Underwriting is listed as a health care operation; the rights section gives members the right to know the reasons for an unfavorable underwriting decision and limits reliance on earlier unfavorable decisions.

Legal Rights & Agreement Rules · User right or choice

Right not to be subjected to pretext interviews

With very limited exceptions, you have the right not to be subjected to pretext interviews. A footnote adds that Aetna does not participate in pretext interviews.

Supporting quotations

With very limited exceptions, not to be subjected to pretext interviews.

We do not participate in pretext interviews.

Qualifications & exceptions

• The right has 'very limited exceptions' that the notice does not describe.
• The footnote says Aetna itself does not participate in pretext interviews.

Not stated here

• The notice does not define 'pretext interviews' or list the exceptions.

Legal Rights & Agreement Rules · User right or choice

How to file a privacy complaint

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, P.O. Box 14079, Lexington, KY 40512-4079. You may also write to the Secretary of the U.S. Department of Health and Human Services. 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 inquiry 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

• The complaint right applies if you think your privacy rights have been violated.
• The no-penalty statement is made in the HHS complaint sentence.

Not stated here

• The notice does not say how Aetna handles or responds to complaints.

Legal Rights & Agreement Rules · Company commitment

Aetna's legal obligations under the federal privacy regulations

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

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.

Aetna’s Legal Obligations

Qualifications & exceptions

• The duty is to follow the notice 'currently in effect'; Aetna may change the notice (see the next card).

Cross-references

• qualified by (model-proposed): Aetna may change the notice and its privacy policies at any time — Aetna's duty to follow the notice currently in effect is qualified by its stated right to change the notice and its privacy policies at any time.

Legal Rights & Agreement Rules · Permission or license

Aetna may change the notice and its privacy policies at any time

Aetna may change the terms of the notice and its privacy policies at any time. If it does, the new terms and policies will apply to all of the information it already has about you as well as any information it receives or holds in the future.

Supporting quotations

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.

This Notice is Subject to Change

Qualifications & exceptions

• Changes apply to information already held, not only future information.
• Aetna's legal obligation is to follow the notice 'currently in effect'.

Not stated here

• The notice does not say how members will be told of a change or whether there is advance notice.

Cross-references

• qualifies (model-proposed): Aetna's legal obligations under the federal privacy regulations — Aetna's duty to follow the notice currently in effect is qualified by its stated right to change the notice and its privacy policies at any time.

Retention & Deletion · Company practice

Information is not destroyed when coverage ends

Aetna says it does not destroy your personal information 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

Please note that we do not destroy your personal information 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 and disclosure after termination is for the purposes described in the notice.
• Aetna says policies and procedures remain in place to protect against inappropriate use or disclosure.

Not stated here

• The notice gives no retention period and does not say whether you can request deletion.

Legal Rights & Agreement Rules · Context

Coverage is underwritten by Aetna Life Insurance Company

The notice says your coverage is underwritten by Aetna Life Insurance Company.

Supporting quotations

Your coverage is underwritten by Aetna Life Insurance Company.

Not stated here

• The notice does not say how this insurer relates to the 'Aetna' group defined at the start of the notice.