1. The AH Personal Health Record Web Portal
Your personal health record (PHR) is your online resource where you can manage and monitor your health information. This information is provided to you within your member website account where the information is private and in a secure location. The information in your PHR is confidential for you to access unless you are under the age of 18 at which time the policy holder (Subscriber) on the contract has access to dependents under the age of 18s PHR. AH does not review the contents of your PHR, except as may be necessary to provide online access (for example, we may incidentally review your data while fixing a technical issue) or as required by law. Your PHR information is updated automatically for you and a version of your PHR can be printed and shared with your health care providers if you choose to do so.
The PHR Content and Management
AH uses personally identifiable information contained in medical and pharmacy claims and certain lab tests and results submitted to AH from doctors, hospitals, labs, pharmacies, and other providers (collectively, Claims Data) to create your PHR that will be available to you. AH will add this Claims Data to your PHR periodically. You also may add information, such as notes, comments, and prior medical history, into your PHR at any time. The content of the PHR does not include claims data relating to what we refer to as sensitive health conditions. Sensitive health condition Claims Data is claims information concerning conditions such as mental or behavioral health, HIV/AIDS, sexually transmitted diseases, substance abuse, or genetic testing. Contents within: (i) the PHR are not a complete medical record and do not include all services, tests, products or medical advice that you may have received, or constitute the official medical record of such services, tests, products or medical advice; (ii) the PHR is not intended to be medical advice or instructional for medical diagnosis or treatment or to suggest or recommend a course of treatment; and (iii) any lab test results received by AH from labs and loaded into the PHR are unofficial records of test results. The AH Claims Data is provided to you for informational purposes only.
The PHR furnished on the AmeriHealth website is not intended to replace personal consultation with a qualified health care professional. Once you accept the AH Website Terms and Conditions, Claims Data submitted to AH will automatically be loaded into your PHR. Claims Data will be uploaded into your website account once the information has been processed by AH.
Although the online version of the PHR you can access will remain unchanged, you have the option to show or hide specific information when you print out your PHR to share with your family and/or health care provider. The most useful PHR is the one that is the most complete and user-friendly, so that it can help you keep track of your health care services you may have received and get services that are necessary. In the event that you are no longer an AH member, you may access your AH PHR for a period of six (6) months after your coverage termination date. AH will not have access to claims information provided by hospitals, physicians, labs, and other providers when you are no longer an AH member. The claims information you will have access to once your coverage is terminated with AH will be only those claims incurred during your effective dates of coverage with AH.
2. Collection of Personal Information from Site Visitors to AH’s Website
3. Use of Online Personal Data Collected Through AH’s Website
When you access the member portal website, you may choose to give AH online personal information about you. Online personal information is any information or data you provide through this website that is individually identifiable, such as a name, address, postal address, email address, birth date, phone number, race, ethnicity, language, gender identity, sexual orientation information, and other personal information including health information that you voluntarily provide to AH. It also may include other information that we collect about you that is associated with your name or address, such as your email address. You will be asked to provide your email address to us during the registration process. And if you email us, the email address used will be collected and saved.
AH may use the online personal information for a number of different reasons, including editorial and feedback purposes, providing information about AH benefit products or offerings and promotions, performing a statistical analysis of visitor usage, product development, content improvement, to protect our rights or property, or to customize the content and layout of our site. Aggregate data that does not identify individual users may be used for internal purposes or provided to third party vendors for program access capabilities. Personally identifiable information that visitors voluntarily provide to AH, online or offline, may be added to our databases and used for future communications, which may include Website updates, new health care products and services, the confirmation of transactions through the portals, upcoming events, or health reminders, and for other purposes in accordance with applicable state and federal law. Online personal information may or may not be individually identifiable health information that is also protected by the federal HIPAA privacy law (the HIPAA Privacy Rule). Where online personal information also constitutes individually identifiable health information under the HIPAA Privacy Rule, the provisions of this Privacy Rule also will govern AH’s permitted uses and disclosures of the online personal information.
4. Disclosure of Online Personal Data Collected Through the AH Website to Third Parties
Unless otherwise authorized by a visitor, AH will not sell, rent, license, or disclose personally identifiable information collected through the AH website to unaffiliated third parties. Under the HIPAA Privacy Rule, however, AH is permitted to disclose individually identifiable health information to business associates who perform various functions or provide services on their behalf. To perform these functions or to provide services, business associates will receive, create, maintain, use, or disclose individually identifiable health information that has been provided to or made available to the business associate by AH, but only after the business associates agrees to sign a business associate agreement designed to safeguard your information. AH has contracted with certain third-party vendors to serve as its business associate to provide services in connection with AH’s web portals. Except as set forth above, AH will not release personally identifiable information to any party unless required to do so by government authorities or legal process in accordance with applicable law, in order to protect our rights or property, or in conjunction with an acquisition of all or part of our company. Laws that permit disclosure of your personally identifiable information as part of healthcare operations might include activities such as Wellness Programs.
5. Health Information Exchanges
We share your health information electronically through certain Health Information Exchanges (HIEs). A HIE is a secure electronic data sharing network. In accordance with applicable federal and state privacy and security requirements, regional health care providers participate in HIEs to exchange patient information in real-time to help facilitate delivery of health care, avoid duplication of services, and more efficiently coordinate care. As a participant in HIEs, AmeriHealth shares your health information we may have received when a claim has been submitted for services you have received among authorized participating providers, such as physicians, hospitals, and health systems for the purpose of treatment, payment and health care operations as permitted by law.
During an emergency, patients and their families may forget critical portions of their medical history which may be very important to the treating physician who is trying to make a quick, accurate diagnosis in order to treat the sick patient. AmeriHealth through its participation in an HIE makes pertinent medical history, including diagnoses, studies, lab results, medications, and the treating physicians we may receive on a claim available to participating emergency room physicians while the patient is receiving care. This is invaluable to the physician, expediting the diagnosis and proper treatment of the patient. Your providers who participate with an HIE, and submit health information with the HIE, will have the ability to access your health information through the HIE and send records to your treating physicians. Through direct requests to the HIE, we will receive various types of protected health information such as pharmacy or laboratory services, or information when you have been discharged from a hospital which may be used to coordinate your care, provide case management services, or otherwise reduce duplicative services and improve the overall quality of care to our members. All providers that participate in HIEs agree to comply with certain privacy and security standards relating to their use and disclosure of the health information available through the HIE.
As an AmeriHealth member, you have the right to opt-out which means your health information will not be accessible through the HIE. Through the State HIE (https://www.dhs.pa.gov/providers/Providers/Pages/Health%20Information%20Technology/Health-Information-Exchange-Providers.aspx) website, consumers or providers can access an online, fax, or mail form permitting patients to remove themselves (opt out) or reinstate themselves (opt back in) to the exchange. It will take approximately one business day to process an opt-out request. If you choose to opt-out of the HIE, your health care providers will not be able to access your information through the HIE. Even if you opt out, this will not prevent your health information from being made available and released through other means (i.e. fax, secure email) to authorized individuals, such as network providers for paying claims, coordinating care, or administering your health benefits in accordance with the law and in the normal course of conducting our business. For more information on HIEs, please go to http://www.dhs.pa.gov.
6. Wellness Programs and Health Support Programs
Wellness and health support programs are intended to help Members to improve their overall health. The health and wellness programs offered via the member portal website are subject to change as we work to enhance and improve certain programs/tools. They are not intended to replace professional medical advice. Information on member participation in these programs may be used by AH for aggregate reporting and outreach purposes. When appropriate, AH may share protected health information (or PHI) with third-party vendors with which AH has a contract to administer benefits or provide health support services as AH’s business associate. Such vendors are required to sign a business associate agreement with AH to maintain the privacy of protected health information as required by law. AH also may share information with treating providers to improve the health care of members. Providers also must follow all legal confidentiality requirements for PHI. In addition, when appropriate, we may confirm your enrollment in these programs or in certain preventive health activities, but not your individual responses or final results, with your employer or health and welfare fund (fund), for the purpose of an incentive program or corporate wellness planning. For example, we may inform your employer or fund that you completed a Health Risk Assessment or Wellness Profile but will not disclose your answers or the status of your health. We may inform your employer or fund that you attended 10 sessions of a weight management program for example, but not disclose whether you lost any weight. Your individual responses also will not be shared with your employer or fund or their broker/consultant.
7. Links from AmeriHealth Websites to Other Websites
8. Security Measures
AH has implemented numerous security features to prevent the unauthorized release of or access to personal information. The AH web portals use 256-bit High Grade Advanced Encryption to help keep information secure. However, despite these and other security measures implemented by AH, no security process is completely foolproof. We will continually assess our security procedures and modify them to protect your information and we ask that our visitors take the appropriate measures to protect their information. If you register for one of our Web Portals, you will have the opportunity to receive or create a password to access view or submit personal information. Visitors who register to use a web portal should not divulge their password to anyone, and AH will never ask for your password in an unsolicited phone call or email. When you are finished with applications that are password-protected, you should exit the application by selecting the Log out button. You should be aware that the confidentiality of any communication or material transmitted to/from AH via this site or email cannot be guaranteed. AH is not responsible for the security of information transmitted via the Internet.
9. Access to and Ability to Correct Online Personal Data
10. Collection of Online Personal Data from Children
Subscribers are able to view their dependent(s) account information for those child dependents on their contract that are under the age of 18. Access regarding the health of their children occurs immediately after a subscriber registers for an account. No longer permitted to register on this Website is any person that is under the age of 18. This includes a dependent on a contract that is under the age of 18 as well as a person (child) under the age of 18 allowed to register to have access to their own account. AH does not direct children under the age of 18 years to access this Website or knowingly collect personal contact information from children under 18. Adults should not assist minors in accessing this Website. When a user enters their personal demographic information on our website during our registration process, the user is confirming that he or she is of the age of 18 years and older. To the extent that AH is able to determine the age of users by their submissions to or communications with AH’s website, AH will not knowingly (1) collect or post information from individuals under age 18 without their parent's or guardian's consent, or (2) provide any personally identifying information collected from children, regardless of its source, to any third party for any purpose whatever unless otherwise permitted by law. No information collected through AH’s website from users who identify themselves as children will knowingly be used for any direct marketing or promotional purposes. If there are no age restrictions on a contest that requires registration, and if a child wins, notification and prizes will be sent to the parents or guardians identified in the initial registration process.
11. AmeriHealth’s Right to Contact Visitor
13. Access to Member Website Information
Plan representatives may access your AmeriHealth member website and other relevant account information to provide customer service requested by you in situations where the provision of customer service would require the Plan representatives to access your AmeriHealth member website and other relevant account information for quality control purposes related specifically to confirming that accounts were setup correctly and that your member information is displaying correctly.
Terms and Conditions of Access
1. The content of the portal is not intended in any way to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Neither the content nor any other service offered by or through the portal is intended to be relied on for medical diagnosis or treatment. Never disregard medical advice or delay in seeking it because of something you have read on the portal! In an emergency, call 911 or call your local emergency assistance number.
2. AH reserves the right to terminate access to the Portal at any time and for any reason. Your access will be terminated after 6 months when your benefits are no longer provided by AH and its subsidiaries or affiliates. AH reserves the right at any time to modify or discontinue, temporarily or permanently, the Portal (or any part thereof) with or without notice. You agree that AH will not be liable to you or to any third party for any modification, suspension, or discontinuance of the Portal.
3. AH has created certain security procedures, including the use of passwords and user identification numbers, to assist in keeping your information confidential. You agree to provide us with accurate, current, and complete information about yourself as requested and to maintain and promptly update your information to keep it accurate, current and complete.
4. You are responsible for maintaining the confidentiality of the password and are responsible for all activities that occur under your password. You agree to immediately notify AH of any unauthorized use of your password or other breach of security, and to exit from your account at the end of each session by selecting the Log out button. AH cannot and will not be liable for any losses and/or damages arising from your failure to comply with these provisions. Except where expressly authorized by law, you certify that you are not using another person’s password or user identification to access the Portal. You agree not to falsely state or otherwise misrepresent your affiliation with a person or entity to obtain access to a Portal. You also agree not to copy or disseminate, electronically or otherwise, personal, or confidential information found on the Portal.
5. You agree that AH, in its sole discretion, may terminate your password, user identification (or any part thereof) or use of the Portal for any reason, including, for lack of use or if AH believes that you have violated the Terms and Conditions. You agree that AH will not be liable to you or any third party for any termination of your access to the Portal.
6. The information provided on the Portal is provided as an accommodation and it is not intended to serve as formal notice or publication as may be required under law or by contract. While AH uses its best efforts to maintain the accuracy and reliability of information available through the Portal, we cannot guarantee the accuracy for all the member benefit and claims information or that all claims will be displaying. Up to two years of claims history is provided to members. You understand and agree that AH, except as expressly required by law, assumes no responsibility for the timeliness, deletion, or failure to provide any information on the Portal.
7. AH has agreements with various entities, which we call our business associates, to provide services in connection with the Portal. Our relationships with business associates are subject to terms of business associate agreements and are based on the type of service they are to provide.
8. Your use of the portal is at your sole risk. The portal is provided on an as is and as available basis. AH expressly disclaims all warranties of any kind, whether express or implied, including, but not limited to the implied warranties of merchantability, fitness for a particular purpose and non-infringement. You expressly understand and agree that AH will not be liable for any direct, indirect, incidental, special, consequential, or exemplary damages for any reason resulting from the use of the portal.
9. You agree to release and hold AH and its subsidiaries and affiliates, and their directors, officers, agents, principals or other partners, and employees, harmless from any claims, demands, damages, losses, liabilities, costs and expenses, including reasonable attorneys; fees, made by any third party due to or arising out of your use of the Portal, your violation of these Terms and Conditions, your communication of inaccurate or incomplete information, and/or your violation of law.
13. The Portal may include or provide links to other websites on the Internet including, but not limited to, links to our business associates; web pages. These other websites may provide opinions, recommendations, or other information from various individuals, organizations, or companies. In providing links to the websites of third parties, AH does not investigate the content of such information and does not endorse, guarantee, or warrant the accuracy of such information or necessarily subscribe to any such opinions or recommendations. To the extent that you make use of any link to any other website on the internet, you understand and agree your use of the websites of third parties is at your sole risk. The websites of third parties are provided on an as is and as available basis. You expressly understand and agree that AH will not be liable for any direct, indirect, incidental, special, consequential, or exemplary damages for any reason resulting from your use of the websites of third parties.
14. You understand that New Jersey and Pennsylvania law requires that any person knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any false information or conceals for the purposes of misleading, information concerning any material fact thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.