Network Health ensures that everyone who handles protected health information within the organization maintains confidentiality at all times. Protected health information includes medical records, claims, benefits and other administrative data that are personally identifiable. Each Network Health employee and committee member must sign a Business Associate Agreement or a Confidentiality Agreement. Network Health routinely reminds employees of the confidential nature of the information held by Network Health.
A member must authorize, in writing, the release or refusal to release any protected health information, unless required or exempt by law.
Consents must specify:
The type of information to be disclosed;
The name of the person authorizing the disclosure;
The name of the recipient of the information;
The purpose for which the information will be used;
The type of health care provider making the disclosure; and
The time period for which the consent applies.
Note: The application form signed by the subscriber at the time of enrollment covers future, known or routine needs for the use of protected health information. It does not provide for release of information beyond the uses specified on the application.
Network Health allows its members the right to consent to specific requests for protected health information in the following instances:
Treatment pertaining to mental illness, developmental disability, alcoholism, drug abuse or HIV testing and disclosure of test results (except as required by law);
Treatment received from non-contracted practitioners/providers;
Workers compensation or auto insurance claims;
Marketing purposes;
Research purposes;
Minors; and/or
Personal representative.
If Network Health is required to obtain informed consent for treatment or special consent for the use of protected health information and a member is unable to give consent, the following people can be authorized by the member.
Guardian or legal custodian of a minor member.
Guardian of a member declared incompetent.
Personal representative or spouse of a deceased member.
Any person authorized in writing by the member.
We may disclose to your employer whether you are enrolled in or have disenrolled from a health plan that your employer sponsors. We may disclose summary health information to your employer to use to obtain premium bids for the health insurance coverage offered under the group health plan in which you participate or to decide whether to modify, amend or terminate that group health plan.
We may disclose your health information and the health information of others enrolled in your group health plan to your employer to administer your group health plan. Before we may do that, your employer must amend the plan document for your group health plan to establish the limited uses and disclosures it may make of your health information. Network Health does not consider use of aggregated data, such as Healthcare Effectiveness Data and Information Set (HEDIS), in which an individual’s personal information is not identifiable, to be subject to privacy restrictions.
Network Health minimizes the use of identifiable data used for quality measurement and protects the information from inappropriate disclosure. Quality initiatives that include collection of measurement data are planned and approved by the Quality Management Committee (QMC) annually. Ad hoc requests for additional quality measurements that are not significantly addressed in the approved quality work plan require separate approval by the QMC. All Network Health employees reviewing protected health information off site will sign a confidentiality agreement and protect the information from being viewed by unauthorized personnel.