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Reference
Appendix and Legal Notices
• For research purposes as permitted and provided
for by law.
• To avert a serious threat to the health or safety of a
person or the public, if consistent with law and ethical
standards.
• For activities deemed necessary by military command
authorities, if you are in the armed forces.
• To comply with workers’ compensation or
similar laws.
• To the Secretary of the Department of Health and
Human Services, if required by law, to investigate or
determine the Plan’s compliance with the law.
Uses and disclosures other than those listed will be
made only with your written authorization. Types of uses
and disclosures requiring authorization include use or
disclosure of psychotherapy notes (with limited excep-
tions); use or disclosure for marketing purposes (with
limited exceptions); and use or disclosure that constitutes
the sale of your PHI.
If you authorize a use or disclosure, you have the right
to revoke that authorization. Your decision to revoke an
authorization must be timely, submitted in writing and
delivered to the Benefits Manager. Your authorization
revocation will apply only to future disclosures of PHI.
Once the Plan has taken action with respect to your
authorization, the authorization can no longer be revoked
for PHI already released.
The privacy of health information that can be used
to identify you or provides information about you is
protected. Not all health information is protected. Health
information that doesn’t identify you or cannot be used to
identify you is not protected. In addition, the protections
described in this notice do not apply to health information
that Aflac can have under applicable law (e.g., the Family
and Medical Leave Act, the Americans with Disabilities
Act, workers’ compensation laws, federal and state
occupational health and safety laws and other state and
federal laws), or that Aflac properly can get for employ-
ment-related purposes through sources other than the
Plan and that is kept as part of your employment records
(e.g., pre-employment physicals, drug testing, fitness for
duty examinations, etc.).
You have the following rights:
You may request restrictions on certain uses and
disclosures of your PHI.
You may request a restriction on use or disclosure for the
purposes of treatment, payment or health-care opera-
tions. Your request must be in writing. The Plan is not
required to agree to this restriction if it would prevent
the Plan from carrying out payment or health-care
operations. Even if the Plan agrees to your request for
restriction, there are exceptions. For example, if you need
emergency treatment, restricted information may be used
or disclosed if it is needed for your treatment. Additionally,
there are certain instances in which uses and disclo-
sures cannot be restricted. For example, if disclosure is
required by law, a restriction would not apply. You may
terminate any restriction that you have requested. The
Plan may terminate any restriction it agreed to without
your approval. A termination by the Plan will affect only
new information – in other words, information created or
received by the Plan after the termination.
You may also request that your health care provider not
disclose your PHI to the Plan for a health care item or
service if you have paid for the item or service out-of-
pocket in full. Please note that if your health care provider
does not disclose the item or service to the Plan, the
amount you paid for the item or service will not count
toward your annual deductible or any out-of-pocket
maximums under the Plan. The provider may also charge
you the out-of-network rate for the item or service.
You have a right to receive confidential (alternative)
communications of PHI.
You may request that PHI be communicated to you at an
alternate address or by alternate means if your request
clearly states that you could be endangered by disclosure
of all or part of your PHI. Your request must be made in
writing and must specify an alternate address or method
of contact. The Plan will accommodate reasonable
requests.
You have the right to access or copy your PHI.
You have a right to inspect and copy certain PHI
maintained by the Plan. Remember that your health-care
provider has the most complete records of your health
care, including information the Plan does not have, use or
maintain. We recommend that you contact your provider
to review your health information. If you want to see the
information maintained by the Plan, you must make the
request in writing to the Aflac Benefits Manager. The
Plan may charge a cost-based fee for supplies, labor and
postage. If you ask for a summary or explanation of your
personal health information, the Plan may charge you for
