2018 Aflac Incorporated Benefits Guide

49 / 77

49
The Plan may disclose health information to the Company, if the
information is needed to carry out administrative functions of the
Plan. In certain cases, the Plan, insurers or HMOs may disclose
your PHI to the Company. 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 benefits
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 benefits 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
benefits 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 disenrollment 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 aggregating 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 entity’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 representative. 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 treatment (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 representative 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, investigations 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 proceeding (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.
• 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.
How to Apply for
Aflac Coverage