The HIPAA (Health Insurance Portability and Accountability Act) place restrictions on Nationwide Health Plans (NHP) ability to disclose protected health information (PHI) about a member or dependent to employers or plan sponsors effective April 14, 2003.
The minimum necessary protected health information may be disclosed to an employer or plan sponsor if:
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the employer or a plan sponsor who is subject to ERISA amends its summary plan description (SPD) and provides NHP with the required HIPAA certification; or |
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the member or member's representative completes and signs an Authorization Form for plan sponsor for use and disclosure of health information (in PDF format). |
Otherwise, NHP will only be able to provide Summary Information for the purposes of 1) obtaining premium bids or quotes; or 2) modifying, amending or terminating a group health plan.
If an employer or a plan sponsor has questions on plan documents and/or certification, you are encouraged to consult with your legal advisor or others who would provide advice on HIPAA privacy requirements.
About Nationwide Health Plans Notice of Privacy Practices
For information about our HIPAA privacy notice, connect to Nationwide Life HIPAA Privacy Statement. It describes the requirements that are to be followed by NHP for its customers and explains the individuals' rights under the law.
Verification Process
Nationwide Health Plans (NHP) collects and maintains protected health information about its members. The federal HIPAA regulations on privacy and confidentiality place restrictions on NHP's ability to use and disclose that information to certain persons without proper verification. In order to protect the privacy and confidentiality of its members' protected health information and to comply with federal law, all NHP workforce members are required to verify the identity of the caller.
If you are the employer, the Customer Service Representative (CSR) will verify your identity by asking for the member's name and address and two or more of the following: member's Social Security number, member's NHP identification number, member's policy number, member's plan sponsor name, member's date of birth, date of treatment/service, if applicable. The CSR will check for an existing authorization on file. If one is on file, the CSR will respond to your inquiry. If no authorization is on file, it is necessary to secure one before the CSR is able to release member specific information.
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