Page 24 - Commercial Group Member Guidebook

Terms and definitionsnfidentially Speaking
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HEALTH CARE INFORMATION, LIKE ANY PRIVATE PROPERTY, SHOULD BE HANDLED
WITH THE UTMOST CARE AND RESPECT.

Confidential information is shared to administer the plan

We take our privacy obligations very seriously. We collect lots of very sensitive medical and other
personal information about our members that needs to be kept strictly confidential. Therefore, we
have very extensive policies about who can and can’t see your private information. But you should
know that we have to share your private information with others in order to administer the health
plan. So companies that perform services for us to administer your plan, and, sometimes even your
employer, depending on what function they serve in administering your plan, will get access to your
private medical information. But these companies all sign confidentiality agreements and they are
strictly prohibited from using the private information for anything other than administering the health
plan. We never sell your private information to anyone.

Confidential information is used in educational programs
One of the main roles managed care companies play is to give members and doctors information
they should know concerning appropriate care. To accomplish this, we have several health
education programs for chronic diseases, like asthma, diabetes and heart failure. We also send
reminders and specially directed educational information about drugs and specific treatments to our
members and their doctors. In some of our programs, directed information is sent to you and/or your
doctors to tell them about what care you and they might consider getting for your diagnosis. The
programs we run are developed with input from practicing physicians and use well-documented,
established facts about treatment and care. We use claim information about you that is in our
system to figure out which members and doctors should be sent educational information from us.

The plan’s rules must be followed. Insurance is complicated.
There are lots of rules to follow. We are making efforts to simplify things, but you really can’t get
around the fact that there are rules you have to follow if you are going to get your care covered by
insurance. Some of the rules require you to notify us before getting care, some of them require you
to get your care only from certain practitioners, some of the rules put limits on the care you can get
and some require you to only get certain types of care. All of the rules are in your Membership
Agreement/Certificate of Coverage. You can also call Member Services at the number referenced
on your member ID card to ask any questions, or if you are unsure about whether you have to follow
any particular rule before getting your care.

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