Federal risk plans notice of privacy practices

Sharing & Disclosure · Context

The Notice covers Aetna Life Insurance Company and its affiliated covered entity

This Notice of Privacy Practices describes the privacy practices of Aetna Life Insurance Company. In the Notice, "Aetna", "we", "us" and "our" mean all of the HMO and licensed insurer subsidiaries of Aetna Inc., which are designated as a single affiliated covered entity (the Aetna ACE) for federal privacy purposes. Members of the Aetna ACE can share Protected Health Information (PHI) with each other for the treatment, payment and health care operations of the Aetna ACE and as HIPAA and this Notice allow. The Notice says what medical information about you may be used and disclosed and how you can get access to it.

Supporting quotations

This Notice of Privacy Practices (Notice) describes the privacy practices of Aetna Life Insurance Company.

refer to all of the HMO and licensed insurer subsidiaries of Aetna Inc.

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.

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

Qualifications & exceptions

• Sharing among ACE members is for treatment, payment and health care operations of the Aetna ACE and as allowed by HIPAA and this Notice.

Not stated here

• The list of ACE members is not in the Notice; it is available by contacting the Aetna Privacy Office at the email given in the Notice.
• A later paragraph describes the Aetna brand more broadly than this definition of "Aetna".

Cross-references

• contrast (model-proposed): Aetna is described as a brand name used by the Aetna group of companies — The opening defines Aetna as the HMO and licensed insurer subsidiaries of Aetna Inc. designated as one affiliated covered entity. The closing line describes Aetna as a brand name used by one or more companies in the Aetna group, including Aetna Life Insurance Company and its affiliates. The Notice does not say whether these are the same set of entities.

Sharing & Disclosure · Permission or license

Aetna may disclose PHI to the U.S. Office of Personnel Management when required by law

Aetna may disclose your PHI to the U.S. Office of Personnel Management (OPM) in connection with payment or health care operations when required by law. It may also disclose your PHI to OPM for the Federal Employees Health Benefits (FEHB) Program and Postal Service Health Benefits (PSHB) Program Claims Data Warehouse when required by law. The first sentence appears in the saved text twice, once split across a page break and once after a page footer.

Supporting quotations

We may disclose your protected health information to the U.S. Office of Personnel Management (OPM) in connection with payment or healthcare operations when required by

We may also disclose your PHI to OPM for its Federal Employees Health Benefits (FEHB) Program and Postal Service Health Benefits (PSHB) Program Claims Data Warehouse when required by law.

We may disclose your protected health information to the U.S. Office of Personnel Management (OPM) in connection with payment or healthcare operations when required by law.

Qualifications & exceptions

• Both OPM disclosures are conditioned on being required by law.

Not stated here

• The Notice does not define the "Federal Risk Plans" label or say which federal programs it ties to this notice beyond the OPM, FEHB and PSHB references.

Sharing & Disclosure · Company practice

Explanation of Benefits mail and online claims information go to the subscriber and covered dependents

Aetna may mail Explanation of Benefits forms and other information to the address it has on file for the subscriber (the primary insured). It also makes claims information available on its secure member website and telephonic claims status sites to the subscriber and all covered dependents. It also uses PHI to get payment for any mail-order pharmacy services you get. The Notice separately says you can ask Aetna to communicate with you at another address, such as for an adult dependent, and can stop the paper mailing of EOBs by registering on Aetna.com.

Supporting quotations

We may also mail Explanation of Benefits forms and other information to the address we have on file for the subscriber (i.e., the primary insured).

We also make claims information on our secure member website and telephonic claims status sites available to the subscriber and all covered dependents.

We also use PHI to get payment for any mail-order pharmacy services you get.

Qualifications & exceptions

• Mailing goes to the subscriber's address on file, not a dependent's address, unless a different address is requested under the rights section.

Not stated here

• The Notice does not say how much of a dependent's claims information the subscriber or other dependents see online or by phone.

Cross-references

• qualified by (model-proposed): You can ask Aetna to communicate with you how or where you choose — Explanation of Benefits forms are mailed to the subscriber's address on file, but you can ask Aetna to communicate with you at another address if the request is reasonable.
• qualified by (model-proposed): You can stop paper mailing of Explanation of Benefits by registering on Aetna.com — Paper mailing of Explanation of Benefits can be stopped by completing the one-time registration on Aetna.com.

Sharing & Disclosure · Permission or license

Aetna may share PHI with your treating providers and for treatment-related reasons

Aetna may share your PHI with the health care providers who take care of you, such as doctors, dentists, pharmacies and hospitals. Sometimes doctors may ask Aetna for your medical information to put in their own records. Aetna may also use your information to offer you mail-order pharmacy services, and may share certain information for patient safety or other reasons linked to your treatment.

Supporting quotations

We may share your PHI with the health care providers who take care of you like your doctors, dentists, pharmacies and hospitals.

Sometimes doctors may ask for your medical information from us to put in their own records.

We may also use your information to offer you mail-order pharmacy services.

And we may also share certain information for patient safety or other reasons linked to your treatment.

Qualifications & exceptions

• Sharing is with providers who take care of you.

Not stated here

• "Other reasons linked to your treatment" is not defined.

Sharing & Disclosure · Permission or license

Aetna may share PHI with other covered entities and their business associates

Aetna may share your PHI with other covered entities or their business associates for treatment, payment or certain health care operations. As an example, if you get your health benefits through an employer, Aetna may share your PHI with other health plans your employer offers, to make sure it pays your claims the right way.

Supporting quotations

We may share your PHI with other covered entities or their business associates.

This may be for treatment, payment, or for certain health care operations.

For example, you may get your health benefits through an employer.

we may share your PHI with other health plans your employer offers.

Qualifications & exceptions

• Purposes are limited to treatment, payment or certain health care operations.
• The employer example applies if you get benefits through an employer.

Sharing & Disclosure · Permission or license

Aetna may share PHI with your employer for plan administration when plan documents allow

For plan administration of group plans, Aetna may share PHI with your employer, as applicable, when Aetna has 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.

Supporting quotations

Plan Administration (Group Plans) – to your employer, as applicable, 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 plans and to the employer "as applicable".
• Condition one: Aetna has been informed that appropriate language is in the plan documents. Condition two: summary data is disclosed to assist in bidding or amending a group health plan.

Not stated here

• The Notice does not describe what the "appropriate language" is or what summary data contains.

Sharing & Disclosure · Permission or license

Aetna may share PHI with researchers if measures protect your privacy

Aetna may share PHI with researchers, provided measures are taken to protect your privacy.

Supporting quotations

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

Qualifications & exceptions

• Conditioned on measures being taken to protect your privacy.

Not stated here

• The Notice does not say what those measures are or who takes them.

Sharing & Disclosure · Permission or license

Aetna may share PHI with business associates who promise to protect it

Aetna may share PHI with persons who provide services to it and assure Aetna they will protect the information.

Supporting quotations

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

Qualifications & exceptions

• The recipients must provide services to Aetna and assure it they will protect the information.

Sharing & Disclosure · Permission or license

Aetna may share PHI with government agencies that regulate it

Aetna may share PHI with government agencies that regulate it, described as agencies of different countries and U.S. state insurance departments.

Supporting quotations

Industry Regulation – to Government agencies that regulate us (different countries and U.S. state insurance departments).

Qualifications & exceptions

• Recipients are regulators of Aetna.

Sharing & Disclosure · Permission or license

Aetna may share PHI for workers' compensation, law enforcement, legal proceedings, public welfare and legal requirements

Aetna may share PHI to comply with workers' compensation laws; with government law enforcement officials; in response to a court order or other lawful process; to address matters of public interest as required or permitted by law, with the examples given being child abuse and neglect, threats to public health and safety, and national security; and to comply with legal obligations and requirements.

Supporting quotations

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

Law Enforcement – to Government law enforcement officials.

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

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).

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

Qualifications & exceptions

• Legal proceedings: in response to a court order or other lawful process.
• Public welfare: as required or permitted by law; the examples are illustrative.

Not stated here

• The law enforcement item states no further condition or legal process requirement.

Sharing & Disclosure · Permission or license

Aetna may share PHI with coroners, funeral directors and organ donation groups

Aetna may share PHI with a coroner or medical examiner to identify a deceased person, determine a cause of death, or as authorized by law, and with 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 directors: as necessary to carry out their duties.

Sharing & Disclosure · Company commitment

Aetna must release PHI to you or your personal representative and to the Department of Health and Human Services

When required, Aetna must release PHI to you or to someone with the legal right to act for you, your personal representative, to help manage your rights under the Notice. It must also release PHI to the Department of Health and Human Services, which may collect it to enforce HIPAA, to comply with HIPAA.

Supporting quotations

There are times when we must share your PHI.

You, or someone who has the legal right to act for you.

The Department of Health and Human Services.

Qualifications & exceptions

• Applies "when required".

Sharing & Disclosure · Permission or license

Aetna may share PHI with people involved in your health care or in paying for it

Aetna may share your PHI with people involved in your health care and with those involved in paying for your care. For example, if a family member or a caregiver calls about a claim, Aetna may tell them what stage it is in.

Supporting quotations

We may share your PHI with people involved in your health care.

We may also share with those involved in paying for your care.

For example, if a family member or a caregiver calls us about a claim, we may tell them what stage it’s in.

Qualifications & exceptions

• The example is about claim status; the Notice does not limit the sharing to that example.

Sharing & Disclosure · User right or choice

You can stop or limit sharing with people involved in your care; minors may block parental views if state law allows

The Notice says you have the right to stop or limit sharing with people involved in your health care or paying for it, by calling the toll-free number on your member ID card. If you are a minor, you may have the right to block parental views of your health information in certain cases, but only if state law allows it. You can call the toll-free number on your ID card, or have your provider talk to Aetna.

Supporting quotations

You have the right to stop or limit this kind of sharing (disclosure).

To do so, just call the toll-free number on your member ID card.

If you’re a minor, you may have the right to block parental views of your health information in certain cases.

But you can only do so if state law allows it.

Or have your provider talk to us.

Qualifications & exceptions

• For minors, the right applies only in certain cases and only if state law allows it.
• The rights section describes this as a right to "ask" Aetna to restrict sharing; see the related card there.

Not stated here

• Which cases let a minor block parental views is not stated.

Cross-references

• contrast (model-proposed): You can ask Aetna to limit uses and sharing, but it may not agree — The sharing section says you have the right to stop or limit sharing with people involved in your care. The rights section says you may ask Aetna to restrict that sharing, and says Aetna may not agree to requests to limit uses and sharing for operations, payment and treatment. The Notice does not say which wording governs the involved-in-care sharing.

Sharing & Disclosure · Context

Recipients may redisclose PHI and it may no longer be protected by HIPAA

PHI that Aetna discloses as HIPAA permits 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

• Applies to PHI disclosed as permitted by HIPAA.