Employee assistance plans notice of privacy practices

Use & Processing · Permission or license

Aetna may use and disclose your information in various ways, including those listed

In administering your EAP Program, Aetna says it may use and disclose personal information about you in various ways 'including' the uses described next (health care operations, payment, treatment, and disclosures to other covered entities). The word 'including' means the list is illustrative. The notice later adds that for situations other than those it describes Aetna will ask for your written authorization, and that stricter state or federal protections for sensitive information are followed where they apply.

Supporting quotations

In administering your EAP Program, we may use and disclose personal information about you in various ways, including:

Qualifications & exceptions

• Modal wording is 'may', not 'will': the notice permits these uses and does not say each one happens for every member.
• Later sections require written authorization for situations not described and require following stricter or more protective laws for sensitive information; those limits apply to this general permission.

Cross-references

• qualified by (model-proposed): Written authorization needed for situations not described — The general list of ways Aetna may use and disclose information is limited by the later statement that in all other situations Aetna will ask for your written authorization.
• qualified by (model-proposed): Right to ask for restrictions; Aetna may not agree — You have the right to ask Aetna to restrict how it uses or discloses information for operations, payment and treatment, but Aetna says it will consider and may not agree.
• qualified by (model-proposed): Information is not destroyed when your employment or EAP services end — The general uses and disclosures are not limited to the period of EAP services: Aetna says it does not destroy the information when services end and may need to keep using and disclosing it for the purposes described.

Use & Processing · Permission or license

Health care operations: running the business, fraud detection, contract and company transfers

Aetna may use and disclose personal information for the operations of its health business, including 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. It also lists detecting and investigating fraud, administering payments, and other general administrative activities such as data 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; licensing; accreditation by independent organizations; performance measurement and outcomes assessment; health services research; and preventive health, disease management, case management and care coordination.

Other operational activities requiring use and disclosure include detection and investigation of fraud; administration of payments;

and other general administrative activities, including data information systems management, and customer service.

Qualifications & exceptions

• 'Such as' and 'include' mark the activities as examples. The permission is for operations, not stated to require your consent.

Cross-references

• qualified by (model-proposed): Aetna follows the stricter law and points to the Privacy Office — Aetna's general permission to use and disclose information for health care operations is qualified by the later statement that it follows the stricter, more protective law where that law applies to it.

Use & Processing · Permission or license

Payment: reviews, collection, cost-sharing and disclosure to your provider

To arrange payment for your EAP services, Aetna may use and disclose personal information to conduct utilization and medical necessity reviews, coordinate care, collect payments, calculate cost-sharing amounts, and respond to complaints, appeals and requests for external review. As an example, it may use your medical history and other health information to decide whether a treatment is medically necessary and what payment should be, and may disclose information to your provider during that process.

Supporting quotations

Payment: To arrange payment for your EAP services, we may use and disclose personal information in a number of ways – in conducting utilization and medical necessity reviews; coordinating care; collecting payments; 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.

Qualifications & exceptions

• 'In a number of ways' and 'for example' mean the activities are illustrative.

Use & Processing · Permission or license

Treatment alternatives, reminders and other health-related benefits and services

Aetna may use or disclose personal information about you in providing you with 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

• The notice separately says it asks for your written authorization for marketing purposes that are unrelated to your benefit plan(s); this passage covers benefits and services, not unrelated marketing.

Not stated here

• The notice does not say who provides these benefits and services or how often they are offered.

Use & Processing · Company commitment

Substance use disorder information: Aetna is not a treatment program

Aetna says it is not a substance use disorder treatment program but may receive or keep information about you that comes from one. If such a program provides the information through a 42 CFR Part 2 consent, including a consent for future uses and disclosures for treatment, payment and health care operations, Aetna says it will use or share the information in accordance with both the consent and HIPAA.

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.

Qualifications & exceptions

• Applies when the information arrives through a Part 2 consent.

Not stated here

• The notice does not say what a Part 2 consent covers beyond the quoted description, or what happens to information that arrives without one.