2022 Archdiocese of Atlanta / Lay Employee Quick Guide - Flipbook - Page 43
How the Plan May Use or Disclose Your Protected Health Information
The following categories describe different ways that the Plan may use and disclose protected health information without your
authorization. For each category, an example is given. Not every kind of use or disclosure within in a category is listed, and
an example is not given for everything. However, all of the ways the Plan is permitted to use and disclose information will
fall within one of the categories. For purposes of this Notice, the term “you” may include your or your estate’s personal
representative, as allowed by HIPAA.
Treatment. The Plan may disclose your protected health information to facilitate medical
treatment or services by your providers such as doctors, nurses, technicians, hospital personnel, or pharmacists. For example,
the Plan might disclose protected health information to your doctor for treatment.
Payment. The Plan may use and disclose protected health information about you to determine
or fulfill its responsibility for coverage and benefits and to obtain or provide reimbursement for health care provided to you.
This might include determining coordination of benefits, adjudicating claims, managing claims, deciding claims and appeals,
obtaining payment under a contract for reinsurance, reviewing appropriateness of care or justification of charges, and
utilization review activities and preauthorization services. For example, the Plan may use or disclose your protected health
information to investigate and resolve disputes or inquiries you may have about payment of benefits. As an another example,
the Plan may disclose your protected health information to another entity that is covered by HIPAA, or to a health care provider,
for the payment activities of the entity or provider that receives the information.
Health Care Operations. Your protected health information that is maintained by the Plan may
be used and disclosed in order to run the Plan’s operations. For example, protected health information may be used or disclosed
for conducting quality assessment and improvement activities, evaluating performance, underwriting (except as limited
below), securing a contract for reinsurance, conducting or arranging for medical review and legal services, business planning
and development, business management and general administrative activities such as customer service and grievances.
Protected health information may be disclosed to another covered entity for certain of the health care operations of that other
entity, when that other entity also has or had a relationship with you. Protected health information may be disclosed among
health plans that the Plan Sponsor maintains or to entities that participate in an organized health care arrangement with the
Plan for any of the health care operations of the covered entities that are within the organized health care arrangement. The
Plan Sponsor is prohibited from using or disclosing protected health information that is genetic information for underwriting
purposes, in accordance with the requirements of the Genetic Information Nondiscrimination Act of 2008 (“GINA”) and
Health Services. The Plan may use your protected health information to contact you with
information about treatment alternatives or other health-related benefits and services that may be of interest to you, or to
provide appointment reminders.
Business Associates. The Plan may contract with individuals or entities known as Business
Associates to perform various functions on its behalf or to provide certain types of services. In order to perform these functions
or to provide these services, Business Associates may receive, create, maintain, use, and/or disclose your protected health
information, but only after they agree to implement appropriate safeguards regarding your protected health information. For
example, the Plan may disclose your protected health information to a Business Associate to administer claims or to provide
As Required By Law. The Plan will disclose protected health information about you when required to do so by
federal, state, local, or any other law, as HIPAA allows or requires. For example, HIPAA requires disclosure to the Secretary
of Health and Human Services in certain circumstances, and federal law sometimes requires disclosure of protected health
information for national security or public health purposes.
Disclosure to Plan Sponsor. Certain employees and members of the workforce of the Plan Sponsor assist with the
Plan’s administrative functions having to do with payment, health care operations, and assistance with treatment. The Plan’s
protected health information about you may be disclosed to these individuals for the performance of Plan administrative
functions or as otherwise required or permitted by HIPAA. In order to make disclosures of protected health information to