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party has made a good faith attempt to provide written notice to you, and the notice provided sufficient information
about the proceeding to permit you to raise an objection and no objections were raised or were resolved in favor of
disclosure by the court or tribunal.

Law Enforcement. The Plan may disclose your PHI when required for law enforcement purposes, including for the
purposes of identifying or locating a suspect, fugitive, material witness or missing person.

Coroners, Medical Examiners and Funeral Directors. The Plan may disclose your PHI when required to be given to a
coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death or other
duties as authorized by law. Also, disclosure is permitted to funeral directors, consistent with applicable law, as
necessary to carry out their duties with respect to the decedent.

Workers’ Compensation. The Plan may release your PHI for workers’ compensation or similar programs that provide
benefits for work-related injuries or illness.

National Security and Intelligence. The Plan may release PHI to authorized federal officials for intelligence,
counterintelligence, and other national security activities authorized by law.

Military and Veterans. If you are a member of the armed forces, the Plan may disclose your PHI as required by military
command authorities. The Plan may also release PHI about foreign military personnel to the appropriate foreign military
authority.

Organ and Tissue Donations. If you are an organ donor, the Plan may disclose your PHI to organizations that handle
organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ
or tissue donation and transplantation.

Research. The Plan may disclose your PHI for research when the individual identifiers have been removed or when the
institutional review board or privacy board has reviewed the research proposal and established protocols to ensure the
privacy of the requested information, and approves the research.

Required Disclosure to Secretary
The Plan is required to disclose your PHI to the Secretary of the U.S. Department of Health and Human Services when
the Secretary is investigating or determining the Plan’s compliance with HIPAA.

Disclosures to Family Members and Personal Representatives
The Plan may disclose your PHI to family members, other relatives and your close personal friends but only to the extent
that it is directly relevant to such individual’s involvement with a coverage, eligibility or payment matter relating to your
care, unless you have requested and the Plan has agreed not to disclose your PHI to such individual. The Plan will
disclose your PHI to an individual authorized by you, or to an individual designated as your personal representative,
provided the Plan has received the appropriate authorization and/or supporting documents. Your personal
representative will be required to produce evidence of his/her authority to act on your behalf before that person will be
given access to your PHI or allowed to take any action for you. Proof of such authority may take one of the following
forms:

• A power of attorney for health care purposes, notarized by a notary public;
• A court order of appointment of the person as the conservator or guardian of the individual; or
• An individual who is the parent of a minor child.

However, the Plan will not disclose information to an individual, including your personal representative, if it has a
reasonable belief that:

• You have been, or may be, subjected to domestic violence, abuse or neglect by such person or treating such person as
your personal representative could endanger you; and
• In the exercise of professional judgment, it is not in your best interest to disclose the PHI.

This also applies to personal representatives of minors.
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