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Reference
Appendix and Legal Notices
Some of the people who administer the Plan work for the
Company. Before your PHI can be used by or disclosed
to these employees, the Company must certify that it has:
(1) amended the Plan documents to explain how your PHI
will be protected, (2) identified the Company employees
who need your PHI to carry out their duties to administer
the Plan, and (3) separated the work of these employees
from the rest of the workforce so that the Company
cannot use your PHI for employment-related purposes
or to administer other benefit plans. For example, these
designated employees will be able to contact an insurer
or third party administrator to find out about the status of
your benefit claims without your specific authorization.
The Plan may disclose information to the Company that
summarizes the claims experience of Plan participants as
a group, but without identifying specific individuals, to get
new benefit insurance or to change or terminate the Plan.
For example, if the Company wants to consider adding
or changing organ transplant benefits, it may receive this
summary health information to assess the costs of those
services.
The Plan may also disclose limited health information to
the Company in connection with the enrollment or disen-
rollment of individuals into or out of the Plan.
The Plan may also use or disclose your PHI for these
additional purposes without your written consent or
authorization:
• To business associates of the Plan that perform
certain administrative services for the Plan and agree
in writing to protect the privacy of your information. In
addition to performing services for the Plan, business
associates may use PHI for their own management
and legal responsibilities and for purposes of aggre-
gating data for Plan design and other health care
operations.
• The Plan and its business associates may disclose
PHI to certain other entities (including other health
plans and health care providers) for the other enti-
ty’s treatment, payment or health care operations
purposes.
• To individuals involved with your care or payment for
your care. The Plan may disclose your PHI to adult
members of your family or another person identified
by you who is involved with your care or payment
for your care if: (1) you authorize the Plan to do so,
(2) the Plan informs you that it intends to do so and
you do not object, or (3) the Plan infers from the
circumstances based upon professional judgment
that you do not object to the disclosure. The Plan will,
whenever possible, try to get your written objection to
these disclosures (if you wish to object), but in certain
circumstances it may rely on your oral agreement or
disagreement to disclosures to family members.
• To personal representatives. The Plan may disclose
your PHI to someone who is your personal represen-
tative. Before the Plan will give that person access to
your PHI or allow that person to take any action on
your behalf, it will require him/her to give proof that
he/she may act on your behalf; for example, a court
order or power of attorney granting that person such
power. Generally, the parent of a minor child will be
the child’s personal representative. In some cases,
however, state law allows minors to obtain treat-
ment (e.g. sometimes for pregnancy or substance
abuse) without parental consent, and in those cases,
the Plan may not disclose certain information to the
parents. The Plan may also deny a personal repre-
sentative access to PHI to protect people, including
minors, who may be subject to abuse or neglect.
• For any purpose required by law, such as responding
to a court order.
• For public health activities as authorized by law or to
comply with law, such as reporting disease, injury,
birth, death or public-health surveillance, investiga-
tions and interventions.
• To the proper government authorities if child abuse or
neglect is reported, or if the Plan reasonably believes
an individual is a victim of abuse, neglect or domestic
violence.
• To a health oversight agency for oversight authorized
by law for audits, investigations, proceedings and
actions.
• In the course of any judicial or administrative pro-
ceeding (for example, responding to a subpoena or
lawful request).
• To a law enforcement official (for example, a court
order, warrant, subpoena, or summons).
• To a coroner, medical examiner or funeral director (for
example, to identify the deceased).
• To facilitate organ, eye or tissue donation and
transplantation.
