Explanation of Benefits mailed to the subscriber’s address
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. Other sections of the notice let you ask for communications to go to a different address and let you stop paper mailing of EOBs by registering online.
Details
Who
Aetna
What it covers
Explanation of Benefits forms and other information
Condition
address on record for the subscriber
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
Address used is the one on record for the subscriber, not necessarily the member
You can ask for a different address and can stop paper EOBs through online registration (rights section)
qualified by (model-proposed): Stop paper mailing of EOBs by registering online — Online registration lets you stop paper mailing of EOBs, which otherwise go to the subscriber’s address on record.
Aetna says it 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. It also may use personal information to provide mail order pharmacy services and send certain information to doctors for patient safety or other treatment-related reasons.
Details
Who
Aetna
Why
treatment and patient safety
What it covers
information held about you, including medical information
Supporting quotations
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
Recipients are providers who take care of you
Stated as “may”
Later sections say stricter state or federal law can limit the disclosure of certain sensitive information
Not stated here
What counts as “certain information” sent for patient safety is not specified
Cross-references
qualified by (model-proposed): Stricter law is followed where it applies — Same qualification applies to disclosures to providers for treatment where a stricter law covers the information.
Disclosure to other covered entities and their business associates
Aetna says it may disclose personal information to other covered entities, or to their business associates, for treatment, payment and certain health care operations purposes. For example, it may disclose information to other health plans maintained by your employer if it has been arranged for Aetna to do so in order to have certain expenses reimbursed.
Details
Who
Aetna
What it covers
personal information
Why
treatment, payment and certain health care operations of other covered entities
Condition
example: arranged disclosure to employer health plans to have expenses reimbursed
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 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
Limited to treatment, payment and certain health care operations purposes
Employer-plan example applies only where it has been arranged for Aetna to do so
Not stated here
Which health care operations purposes are “certain” is not specified
Sharing & Disclosure · Company practice
“Aetna” means a group of subsidiaries that share protected health information
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 as 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 the group and as allowed by HIPAA and this notice. A full list of the members is available by contacting the Aetna Privacy Office at PrivacyAetna@aetna.com.
Details
Who
members of the Aetna affiliated covered entity (HMO and licensed insurer subsidiaries of Aetna Inc.)
What it does
share protected health information with each other
Why
treatment, payment and health care operations, and as allowed by HIPAA
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
Sharing within the group is for treatment, payment and health care operations and as allowed by HIPAA and this notice
The footnote is split across a page break in the source (it ends “These” and continues “entities”) and is read here as one passage
Not stated here
The member list is not in the notice; whether the mail order pharmacy entity named at the end of the notice is a member is not stated
Sharing & Disclosure · Permission or license
Disclosure to your employer for plan administration
Aetna says it may disclose health information to your employer in support of plan administration, either 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.
Details
Who
Aetna
What it covers
health information; summary data
Why
plan administration; bidding or amending a group health plan
Condition
informed that appropriate language is in plan documents, or summary data only
Supporting quotations
We also may disclose such information in support of:
Plan Administration – to your employer, 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
Two stated circumstances: Aetna has been informed appropriate language is in the plan documents, or summary data is disclosed for bidding or amending a group health plan
Stated as “may”
Not stated here
The notice does not say what the “appropriate language” is, or what information beyond summary data the employer can receive under the first circumstance
Disclosure to regulators and for workers’ compensation
Aetna says it 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, and to comply with workers’ compensation laws.
Details
Who
Aetna
Why
regulatory oversight; compliance with workers’ compensation laws
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.
Qualifications & exceptions
Regulator recipients are agencies that regulate Aetna
Workers’ compensation disclosure is to comply with those laws
Stated as “may”
Not stated here
“Other government agencies that regulate us” is open-ended and no agencies beyond those named are identified
Disclosure to law enforcement and in legal proceedings
Aetna says it may disclose health information to federal, state and local law enforcement officials, and in response to a court order or other lawful process.
Details
Who
Aetna
Why
law enforcement; response to 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
Stated as “may”
Legal proceedings disclosure is in response to a court order or other lawful process
Later sections say stricter state or federal law can limit the disclosure of certain sensitive information
Not stated here
The law enforcement entry states no conditions of its own, and what counts as “other lawful process” is not defined
Disclosure for public welfare and as required by law
Aetna says it may disclose health 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, and to comply with legal obligations and requirements.
Details
Who
Aetna
Why
matters of public interest; compliance with legal obligations
Condition
as required or permitted by law
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).
As Required by Law – to comply with legal obligations and requirements.
Qualifications & exceptions
Public welfare disclosures are those “required or permitted by law”
Examples are introduced by “e.g.” and are not a closed list
Stated as “may”
Not stated here
Recipients of public welfare disclosures are not named
Disclosure about deceased people and organ donation
Aetna says it 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.
Details
Who
Aetna
Why
identifying a deceased person, cause of death, funeral duties, organ 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 disclosure is limited to what is necessary to carry out their duties
Disclosure to people involved in your care, and your right to stop it
Aetna says it may disclose personal information to a relative, friend, the subscriber of your health 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. You have the right to stop or limit this kind of disclosure by calling the toll-free Customer Service number given in the notice.
Details
Who
Aetna
What it covers
personal information
Condition
directly relevant to the person’s involvement in your care or payment
What it does
call 1-888-772-9682 to stop or limit
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.
You have the right to stop or limit this kind of disclosure by calling the toll-free Customer Service number at 1-888-772-9682.
Qualifications & exceptions
Condition: information is directly relevant to the person’s involvement with your care or payment
The example involves a caller who already knows about the claim
You can stop or limit this kind of disclosure by phone
Not stated here
The notice does not say how quickly a stop or limit takes effect
Cross-references
contrast (model-proposed): Right to ask for restrictions, which Aetna may refuse — One section describes a right to stop or limit disclosure to people involved in your care by phone; the rights section describes a right to ask Aetna to restrict such disclosures. The notice does not say whether the request can be refused for these disclosures, as it can for operations, payment and treatment.
Sharing & Disclosure · Context
Information disclosed under HIPAA may be redisclosed
The notice warns that protected health information disclosed as permitted by HIPAA may be redisclosed by the recipient and may then no longer be protected by HIPAA.
Details
What it covers
PHI disclosed as permitted by HIPAA
Who
recipient
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
Not stated here
The notice does not say which recipients or what other protections might apply after redisclosure