We will not disclose your nonpublic personal information unless we are allowed or required by law to do so. The following categories describe the ways that we may use and disclose your nonpublic personal information. For each category of uses and disclosures, we will explain what we mean and present some examples. Not every use or disclosure we might make will be listed. However, all the ways we are permitted to use and disclose information will fall within one of the categories.
Note: Some of the uses and disclosures described in this notice may be limited in certain cases by applicable State laws that are more stringent than Federal laws, including disclosures related to mental health and substance abuse, developmental disability, alcohol and other drug abuse (AODA), and HIV testing.
We are allowed to use and disclose information that falls within one of the following categories:
1. Payment. We may use and disclose your health information to make and collect payment for treatment and services you receive, such as: determining your eligibility for plan benefits, obtaining premiums, determining your health plan's responsibility for benefits, and collecting payment for your health services.
2. Health Care Operations. We may use and disclose your health information to support our business activities and improve our coverage and services. Health care operations include such activities as: Underwriting, premium rating, and other functions related to plan coverage. However, we are not allowed to use genetic information to decide whether we will give you coverage or the price of that coverage.
- Quality assessment and improvement activities.
- Activities designed to improve health and reduce health care cost.
- Case management and care coordination.
- Accreditation, certification, licensing, and credentialing activities.
- Reviews and auditing, including fraud and abuse detection programs, medical reviews, legal services, audit services, and compliance programs.
- Submitting claims for stop-loss coverage.
- Business planning, management, and general administrative activities, including customer service and resolution of grievances.
Notice: We are part of an Organized Health Care Arrangement (OHCA) with SSM Health and Dean
Health System. As part of the OHCA, we may from time to time share your information with other
members of the OHCA in order to perform joint health care operations. These uses and disclosures
allow the OHCA to run efficiently. For example, we may share your information in order to: improve
population health management; conduct quality assessment and improvement activities; conduct or
arrange for medical review, legal services, audit services, and fraud and abuse detection programs;
business planning and development such as cost management; and business management and general
OHCA administrative activities.
3. Treatment. We may disclose your health information to a physician or other health care provider that is treating you. We may contact you with information on treatment alternatives and other related functions that may be of interest to you.
4. Distributing Health-Related Benefits and Services. We may use and disclose your health information to provide information on health-related benefits and services that may be of interest to you.
5. Disclosure to Plan Sponsors. If applicable, we may disclose your health information to the sponsor of your group health plan for purposes of administering benefits under the plan. If you have a group health plan, your employer is the plan sponsor.
6. Public Safety. We can share health information about you for certain situations such as: preventing disease; helping with product recalls; reporting adverse reactions to medications; reporting suspected abuse, neglect, or domestic violence; and preventing or reducing a serious and imminent threat to the health or safety of a particular person or the public.
7. Research. Under certain circumstances, and only after a special approval process, we may use and disclose your health information to help conduct research.
8. Required by Law. We will share information about you if laws require it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.
9. Workers’ Compensation, Law Enforcement, and Other Government Requests. We can use and share health information about you: for workers’ compensation claims; for law enforcement purposes or with a law enforcement official; with health oversight agencies for activities authorized by law; and for special government functions such as military, national security, and presidential protective services.
10. Legal Actions. We may disclose your health information in the course of any administrative or judicial proceeding.