Page 38 - PA_PPO_Member_Kit

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If one of the above reasons does not apply, we must get your written permission to use or disclose your member
information. If you give us written permission and change your mind you may cancel your written permission at any
time. Cancellation of your permission will not apply to any information we have already disclosed. We may ask you
to complete a form when making a request. Once you give us authorization to release your member information, we
cannot guarantee that the person to whom the information is provided will not disclose the information.
Other Uses of Health Information
• We may release your member information to a friend, family member or other individual who is authorized by law
to act on your behalf. For example, parents may obtain information about their children covered by HAP, even if
the parent is not covered by HAP.
• We may use or share your information with an employee benefit plan through which you receive health benefits.
Except for enrollment information or summary health information and as otherwise required by law, we will
not share your information with an employer or plan sponsor unless the employer or plan sponsor has provided
us with written assurances that the information will be kept confidential and will not be used for an improper
purpose. Generally, information will only be shared when needed by the employer/plan sponsor to administer
your health benefit plan.
• We may give a limited amount of information to someone who helps pay for your care. For example, if your
spouse contacts us about a claim, we may tell him/her whether the claim has been paid.
• We may use your information so that we can contact you, either by phone or by mail, in order to conduct surveys,
such as the annual member satisfaction survey.
• In certain extraordinary circumstances, such as a medical emergency, we may release your information as
necessary to a friend or family member who is involved in your care, if we determine that the release of
information is in your best interest. For example, if you have a medical emergency in a foreign country and are
unable to contact us directly, we may speak with a friend or family member who is acting on your behalf.
Your Member Rights
The following are your rights with respect to your member information. If you would like to exercise the following
rights, please contact us as described below, under “Who to Contact”.
• You have the
right to ask us to restrict
how we use or disclose your member information for treatment, payment,
or health care operations. You also have the right to ask us to restrict member information that we have been
asked to give to family members or to others who are involved in your health care or payment for your health care.
Please note that we are not required to agree to these restrictions.
• You have the right to ask to receive confidential communications
of information. For example, if you believe
that you would be harmed if we send your information to your current mailing address (for example in situations
involving domestic disputes or violence), you can ask us to send the information by alternative means, for
example, by fax or to an alternative address.
We will try to accommodate reasonable requests.
• You have the right to inspect and obtain a copy
of member information
that we maintain about you. We may
deny your request to inspect and copy your member information in certain, limited circumstances. For example,
we may deny your request if review of the records could endanger you or another person. We may charge you
a fee for copies. We will inform you in advance of the fee and provide you with an opportunity to withdraw or
modify your request.
• You have the right to ask us to amend
member information we maintain about you. We will require that the
information you provide be accurate. We are unable to delete any part of a legal record, such as a claim submitted
by your doctor.
Please note that we are not required to agree to a request to amend.