Privacy and Rights Regarding Wisconsin Health Insurance

How Do the Privacy of Health Information Provisions Affect Me?

Both federal and state laws offer some protection your personal medical information. The federal privacy laws apply to both health care providers and insurance companies. More information on the federal privacy laws can be obtained by visiting the United States Department of Health and Human Services Web site at http://www.hhs.gov/ocr/hipaa.

Wisconsin insurance law includes requirements that insurance companies must meet when obtaining and using your personal medical information. Insurance companies may require your personal medical information in two situations. First, it is often necessary for an insurance company to review your medical records to determine the risk (how much it will cost to pay potential claims) associated with offering insurance coverage to you Second, it is often necessary for an insurance company to review your medical records to determine whether the claims you submit for payment are eligible for coverage under the terms of the policy.

An insurance company cannot obtain your persona medical information without your written consent. An insurance company can either request written consent at the time of your application for coverage or as it finds necessary for the processing of a claim for benefits under your policy. If an insurance company obtains a signed disclosure authorization as part of the application for coverage, it must indicate in the disclosure authorization the purposes for which the disclosed personal medical information will be used. A disclosure authorization authorizing the company to obtain personal medical information for the purpose of making coverage decisions cannot be valid for longer than 30 month from the date on which it is signed. However, an authorization authorizing the company to obtain personal medical information in connection with a claim for benefits is valid for as long as your policy is in force and until all claims pending under the policy are processed. If an insurance company requests written consent to obtain your personal medical information only as it finds necessary for the processing of a particular claim or claims, it must obtain a signed disclosure authorization each time it requires an individual's personal medical information.

What Are My Rights?

• You have the right to refuse an insurance company access to your personal medical information. However, doing so may result in the insurance company having insufficient information to determine eligibility for coverage, premium rates, or policy benefits.
• You have the right to request all personal medical information regarding you and your minor dependents in an insurance company's possession.
• You have the right to request the correction, amendment, or deletion of any personal medical information regarding you or your minor dependents in an insurance company's possession.