Page 17 - 2016 WFF Guide 1
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U ses and d isclosures relating to treatment, payment, or health care operations T o the Plan ’ s S erv i c e
T reatm en t: generally, and as you w ould ex pect, the P lan is permitted Prov i ders: the P lan may
to d isclose your P H I for purposes of your med ical treatment. Thus, it d isclose P H I to its serv ice
may d isclose your P H I to d octors, nurses, hospitals, emergency med ical prov id ers ( “ business
technicians, pharmacists, and other health care professionals w here the associates” ) w ho perform claim
d isclosure is for your med ical treatment. F or ex ample, if you are inj ured in payment and plan management
an accid ent, and it’ s important for your treatment team to k now your blood serv ices. The P lan req uires a
type, the P lan could d isclose that P H I to the team in ord er to allow it to more w ritten contract that obligates
effectiv ely prov id e treatment to you. the business associate to
safeguard and limit the use of
Paym en t: of course, the P lan’ s most important function, as far as you are P H I .
concerned , is that it pays for all or some of the med ical care you receiv e
( prov id ed the care is cov ered by the P lan) . I n the course of its payment R eq ui red b y L aw : the P lan
operations, the P lan receiv es a substantial amount of P H I about you. F or may d isclose P H I w hen a
ex ample, d octors, hospitals, and pharmacies that prov id e you care send the law req uires that it report
P lan d etailed information about the care they prov id ed , so that they can be information about suspected
paid for their serv ices. The P lan may also share your P H I w ith other plans, abuse, neglect, or d omestic
in certain cases. F or ex ample, if you are cov ered by more than one health v iolence, or relating to
care plan ( e.g., cov ered by this P lan and your spouse’ s plan or cov ered by suspected criminal activ ity, or
the plans cov ering your father and mother) , w e may share your P H I w ith the in response to a court ord er.
other plans to coord inate payment of your claims. I t must also d isclose P H I
to authorities that monitor
H ealth C are O p erati on s: the P lan may use and d isclose your P H I in the compliance w ith these priv acy
course of its “ health care operations.” F or ex ample, it may use your P H I in req uirements.
ev aluating the q uality of serv ices you receiv ed or d isclose your P H I to an
accountant or attorney for aud it purposes. I n some cases, the P lan may F or Pub li c H ealth A c ti v i ti es:
d isclose your P H I to insurance companies for purposes of obtaining v arious the P lan may d isclose P H I w hen
insurance cov erage. H ow ev er, the P lan w ill not d isclose, for und erw riting req uired to collect information
purposes, P H I that is genetic information. about d isease or inj ury, or to
report v ital statistics to the
O ther uses and d isclosures of your P H I not req uiring authoriz ation public health authority.
The law prov id es that the P lan may use and d isclose your P H I w ithout authoriz ation in F or H ealth O v ersi ght
A c ti v i ti es: the P lan may
the follow ing circumstances: d isclose P H I to agencies or
T o the Plan S p on sor: the P lan may d isclose P H I to the employers ( such as d epartments responsible for
the Company) who sponsor or maintain the Plan for the beneit of employees monitoring the health care
and d epend ents. H ow ev er, the P H I may only be used for limited purposes, system for such purposes as
and may not be used for purposes of employment- related actions or reporting or inv estigation of
decisions or in connection with any other beneit or employee beneit plan of unusual incid ents.
the employers. P H I may be d isclosed to: the human resources or employee R elati n g to D ec eden ts: the
beneits department for purposes of enrollments and disenrollments, P lan may d isclose P H I relating
census, claim resolutions, and other matters related to P lan ad ministration; to an ind iv id ual’ s d eath to
payroll d epartment for purposes of ensuring appropriate payroll d ed uctions coroners, med ical ex aminers, or
and other payments by cov ered persons for their cov erage; information funeral d irectors, and to organ
technology d epartment, as need ed for preparation of d ata compilations and procurement organiz ations
reports related to Plan administration; inance department for purposes of relating to organ, eye, or tissue
reconciling appropriate payments of premium to and beneits from the Plan, d onations or transplants.
and other matters related to P lan ad ministration; internal legal counsel to
assist w ith resolution of claim, cov erage, and other d isputes related to the
Plan’s provision of beneits.
2016 Open Enrollment
U ses and d isclosures relating to treatment, payment, or health care operations T o the Plan ’ s S erv i c e
T reatm en t: generally, and as you w ould ex pect, the P lan is permitted Prov i ders: the P lan may
to d isclose your P H I for purposes of your med ical treatment. Thus, it d isclose P H I to its serv ice
may d isclose your P H I to d octors, nurses, hospitals, emergency med ical prov id ers ( “ business
technicians, pharmacists, and other health care professionals w here the associates” ) w ho perform claim
d isclosure is for your med ical treatment. F or ex ample, if you are inj ured in payment and plan management
an accid ent, and it’ s important for your treatment team to k now your blood serv ices. The P lan req uires a
type, the P lan could d isclose that P H I to the team in ord er to allow it to more w ritten contract that obligates
effectiv ely prov id e treatment to you. the business associate to
safeguard and limit the use of
Paym en t: of course, the P lan’ s most important function, as far as you are P H I .
concerned , is that it pays for all or some of the med ical care you receiv e
( prov id ed the care is cov ered by the P lan) . I n the course of its payment R eq ui red b y L aw : the P lan
operations, the P lan receiv es a substantial amount of P H I about you. F or may d isclose P H I w hen a
ex ample, d octors, hospitals, and pharmacies that prov id e you care send the law req uires that it report
P lan d etailed information about the care they prov id ed , so that they can be information about suspected
paid for their serv ices. The P lan may also share your P H I w ith other plans, abuse, neglect, or d omestic
in certain cases. F or ex ample, if you are cov ered by more than one health v iolence, or relating to
care plan ( e.g., cov ered by this P lan and your spouse’ s plan or cov ered by suspected criminal activ ity, or
the plans cov ering your father and mother) , w e may share your P H I w ith the in response to a court ord er.
other plans to coord inate payment of your claims. I t must also d isclose P H I
to authorities that monitor
H ealth C are O p erati on s: the P lan may use and d isclose your P H I in the compliance w ith these priv acy
course of its “ health care operations.” F or ex ample, it may use your P H I in req uirements.
ev aluating the q uality of serv ices you receiv ed or d isclose your P H I to an
accountant or attorney for aud it purposes. I n some cases, the P lan may F or Pub li c H ealth A c ti v i ti es:
d isclose your P H I to insurance companies for purposes of obtaining v arious the P lan may d isclose P H I w hen
insurance cov erage. H ow ev er, the P lan w ill not d isclose, for und erw riting req uired to collect information
purposes, P H I that is genetic information. about d isease or inj ury, or to
report v ital statistics to the
O ther uses and d isclosures of your P H I not req uiring authoriz ation public health authority.
The law prov id es that the P lan may use and d isclose your P H I w ithout authoriz ation in F or H ealth O v ersi ght
A c ti v i ti es: the P lan may
the follow ing circumstances: d isclose P H I to agencies or
T o the Plan S p on sor: the P lan may d isclose P H I to the employers ( such as d epartments responsible for
the Company) who sponsor or maintain the Plan for the beneit of employees monitoring the health care
and d epend ents. H ow ev er, the P H I may only be used for limited purposes, system for such purposes as
and may not be used for purposes of employment- related actions or reporting or inv estigation of
decisions or in connection with any other beneit or employee beneit plan of unusual incid ents.
the employers. P H I may be d isclosed to: the human resources or employee R elati n g to D ec eden ts: the
beneits department for purposes of enrollments and disenrollments, P lan may d isclose P H I relating
census, claim resolutions, and other matters related to P lan ad ministration; to an ind iv id ual’ s d eath to
payroll d epartment for purposes of ensuring appropriate payroll d ed uctions coroners, med ical ex aminers, or
and other payments by cov ered persons for their cov erage; information funeral d irectors, and to organ
technology d epartment, as need ed for preparation of d ata compilations and procurement organiz ations
reports related to Plan administration; inance department for purposes of relating to organ, eye, or tissue
reconciling appropriate payments of premium to and beneits from the Plan, d onations or transplants.
and other matters related to P lan ad ministration; internal legal counsel to
assist w ith resolution of claim, cov erage, and other d isputes related to the
Plan’s provision of beneits.
2016 Open Enrollment
