Privacy & confidentiality
Contracted providers are required to maintain confidentiality of member information and records, in accordance with applicable laws.
Member consent and confidentiality
We have implemented numerous initiatives to safeguard the confidentiality of member's personal health information. Employees are required to sign the Code of Ethics and Business Conduct when hired and each year thereafter. This document specifically addresses the confidentiality of member information and unauthorized release or access to these data. In addition, physician contracts stress the importance of maintaining the confidentiality of individual medical records and physician consultants are required to sign confidentiality statements. These policies ("A Word About Confidentiality") are in place to heighten the awareness of protecting the privacy of personal health information.
Protection of privacy in all settings
The Plan has taken numerous steps to see that the personal information of our members is kept confidential and to prevent the unauthorized release of or access to these data. All Plan employees sign confidentiality statements regarding member information annually. All Plan contracted practitioners and providers are required to maintain confidentiality of member information and records in accordance with applicable laws.
Members unable to give consent
When the Plan needs to obtain consent for the release of personal health information, authorization of care and treatment, or to have access to information from a member who is unable to provide it, the Plan will obtain consent from the parent, legal guardian, next of kin, or other individual with appropriate legal authority to make decisions on behalf of the member.
Access to medical records
The Plan does not maintain member medical records. Medical records are maintained by the practitioners and providers who create them, and members can access such medical records from such practitioners and providers. Upon a member's request, the Plan will provide the member with a summary of any of his or her personally identifiable information maintained by us. At any time, any member may request that we modify, correct, change, or update his or her personally identifiable information that we maintain by contacting us by postal mail, email, or telephone.
Inclusion in routine consent
It may be necessary for us to maintain and release a member's records, claims related information, or health-related information to third parties (e.g., regulatory agencies). By enrolling with us, each member gives his or her consent to us to maintain and release member's records to see that health care is provided to the member or is paid for, to perform our contractual obligations to the member or to assist us in doing so, or to fulfill a legal mandate.
Right to approve release of information
In certain circumstances, it is required by law to obtain a member's consent before releasing unique member health information. If the member gives consent for us to release the information, the member has the right — at any time — to revoke his or her consent (except to the extent we relied on the consent while it was in effect). There could be circumstances, however, such as a subpoena issued by a court or a request from a regulatory agency, where a member's consent is not required before releasing such information.
Use of measurement data
At times we may utilize membership data to develop or enhance our health benefits and services. Patient identity will be kept anonymous wherever possible.