The Plan may use and disclose your PHI for the purposes of treatment, payment, and health care operations. Examples of the uses and disclosures that the Plan may make under each purpose are listed below.
Treatment: Refers to the provision of health care by a doctor, hospital, or other health care provider. The Plan generally does not use or disclose your PHI for treatment, but is permitted to do so, if necessary. For example, the Plan may disclose to your treating specialty provider the name of your treating general medical provider so that the specialty provider may have the necessary medical records to evaluate your medical condition.
Payment: Refers to the activities that the Plan undertakes in the payment of claims for covered services received by Plan participants. Examples of uses and disclosures under this section include determination of medical necessity of a treatment or service and what the allowable charge should be; determining if a treatment or service is covered by the Plan; and sharing PHI with insurers in order to settle subrogation claims and to perform coordination of benefits.
Health Care Operations: Refers to the basic functions necessary to operate the Plan. Examples of uses and disclosures under this section include the use of PHI to evaluate the performance of the Plan’s vendors; the disclosure of PHI to provide disease management programs to participants with specific health conditions; the disclosure of PHI to vendors under contract with the Plan who provide consulting, actuarial, claims review, and legal services to the Plan; the use and disclosure of PHI for general administrative functions such as responding to complaints or appeals; the use and disclosure of PHI for data and information management; and the use and disclosure of PHI for general data analysis used for planning, managing, and evaluation purposes.
Disclosures to the Plan’s Business Associates The Plan may disclose your PHI to its business associates as part of contracted agreements to perform services for the Plan, provided that the business associate agrees to protect the information.
Disclosure for Health Related Products and Services
The Plan treatment to you. regarding
or its business associates may contact you to provide alternatives or other health-related benefits and services that For example, the Plan’s utilization management vendor a disease management program.
information about may be of interest may contact you
Disclosures to Other Covered Entities The Plan may disclose your PHI to other covered entities or business associates of those covered entities for the purposes of treatment, payment, and certain health care operations. For example, the Plan may disclose PHI to another health plan in order to perform coordination of benefits.