Page 48 - HarborLight CU 2014-15 SPD
P. 48
HOW WE MAY USE AND DISCLOSE YOUR PHI
The following categories describe the ways that we use and disclose health information. Not
every use or disclosure in a category will be listed. However, all of the ways we are permitted to
use and disclose information will fall into one of the categories. We will provide examples to
assist in describing the PHI, how it is disclosed, who it is disclosed to and for the reason for the
disclosure.
For Treatment. The Plan may use or disclose PHI for medical treatment and services. For
example, if your medical care needs to be coordinated we may disclose health information about
you to doctors, nurses, therapists or medical facilities.
For Payment. The Plan may use and disclose PHI so that the treatment and services you
receive may be billed and payment may be made to the medical care provider that provided care
to you. For example, we may need to provide your PHI to a third party administrator so that they
will pay claims for your care.
For Health Care Operations. The Plan may use and disclose PHI for Plan operations. Theses
uses and disclosures are necessary to run the Plan and ensure our members receive quality
services. For example, the Plan may use health information and disclosure it to the Plan Sponsor
to review benefit coverage options.
To the Company. In certain instances, the Plan may disclose you PHI to some of the people
who administer the Plan for the Company. Before your PHI can be used by or disclosed to these
Company employees, the Company must certify that it has: (a) amended the Plan documents to
explain how you PHI will be protected; (b) identified the Company employees who need your PHI
to carry out their duties to administer the Plan; and (c) separated the work of these employees
from the rest of the workforce so that the Company cannot use your PHI for employment-related
purposes or to administer other benefit plans. For example, these designated employees will be
able to contact an insurer or third party administrator to find out about the status of your benefits
claim without you specific authorization.
The Plan may disclose information to the Company that summarizes the claims experience of the
Plan participants as a group, but without identifying specific individuals, to obtains new benefit
insurance or to change or terminate the Plan. For example, if the Company wants to consider
adding or changing organ transplant benefits, it may this summary health information to assess
the costs of those services.
The Plan may also disclose limited health information to the Company in connection with the
enrollment or disenrollment into or out of the Plan.
To Business Associates. The Plan may hire third parties that may need PHI to perform certain
services on behalf of the Plan. The third parties are Business Associates of the Plan. Business
Associates (and their subcontractors) must protect any PHI they receive from, or create and
maintain on behalf of, the Plan. For example, the Plan may hire a third party administrator to
process claims, an auditor to review how an insurer or third party administrator is processing
claims, an insurance agent to assess coverages and assist with claims problems or a service
provider to provide health benefits.
For Treatment Alternatives. We may use and disclose health information to tell you about
possible treatment options or alternatives that may be of interest to you.
To Individuals Involved in Your Care or Payment for Your Care. The Plan may disclose your
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The following categories describe the ways that we use and disclose health information. Not
every use or disclosure in a category will be listed. However, all of the ways we are permitted to
use and disclose information will fall into one of the categories. We will provide examples to
assist in describing the PHI, how it is disclosed, who it is disclosed to and for the reason for the
disclosure.
For Treatment. The Plan may use or disclose PHI for medical treatment and services. For
example, if your medical care needs to be coordinated we may disclose health information about
you to doctors, nurses, therapists or medical facilities.
For Payment. The Plan may use and disclose PHI so that the treatment and services you
receive may be billed and payment may be made to the medical care provider that provided care
to you. For example, we may need to provide your PHI to a third party administrator so that they
will pay claims for your care.
For Health Care Operations. The Plan may use and disclose PHI for Plan operations. Theses
uses and disclosures are necessary to run the Plan and ensure our members receive quality
services. For example, the Plan may use health information and disclosure it to the Plan Sponsor
to review benefit coverage options.
To the Company. In certain instances, the Plan may disclose you PHI to some of the people
who administer the Plan for the Company. Before your PHI can be used by or disclosed to these
Company employees, the Company must certify that it has: (a) amended the Plan documents to
explain how you PHI will be protected; (b) identified the Company employees who need your PHI
to carry out their duties to administer the Plan; and (c) separated the work of these employees
from the rest of the workforce so that the Company cannot use your PHI for employment-related
purposes or to administer other benefit plans. For example, these designated employees will be
able to contact an insurer or third party administrator to find out about the status of your benefits
claim without you specific authorization.
The Plan may disclose information to the Company that summarizes the claims experience of the
Plan participants as a group, but without identifying specific individuals, to obtains new benefit
insurance or to change or terminate the Plan. For example, if the Company wants to consider
adding or changing organ transplant benefits, it may this summary health information to assess
the costs of those services.
The Plan may also disclose limited health information to the Company in connection with the
enrollment or disenrollment into or out of the Plan.
To Business Associates. The Plan may hire third parties that may need PHI to perform certain
services on behalf of the Plan. The third parties are Business Associates of the Plan. Business
Associates (and their subcontractors) must protect any PHI they receive from, or create and
maintain on behalf of, the Plan. For example, the Plan may hire a third party administrator to
process claims, an auditor to review how an insurer or third party administrator is processing
claims, an insurance agent to assess coverages and assist with claims problems or a service
provider to provide health benefits.
For Treatment Alternatives. We may use and disclose health information to tell you about
possible treatment options or alternatives that may be of interest to you.
To Individuals Involved in Your Care or Payment for Your Care. The Plan may disclose your
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