Privacy

Fallon Health’s (Fallon) Privacy Policy protects the confidentiality of member records and information. Relevant elements of our policy are:

  1. Fallon creates, collects, maintains and processes Protected Health Information (PHI) about members for the purpose of treatment, payment and health care operations.
  2. Fallon’s contracted providers are required to implement appropriate administrative, physical, and technical safeguards to prevent the unauthorized use and disclosure of PHI in accordance with applicable federal and state laws.
  3. Fallon and its contracted providers must have policies and procedures in place for obtaining consents from members  or their duly authorized representatives prior to releasing PHI to third-parties including employer group plan sponsors.
  4. Fallon and its contracted providers must ensure that members or their duly appointed representatives have timely access to their records with the appropriate written release signed by the member or authorized representative.
  5. Fallon may disclose enrollment and summary health information to fully insured employer group sponsors for the purpose of enrollment, disenrollment, obtaining premium bids as well modifying amending or terminating group health plans.
  6. Fallon may disclose enrollment and summary health information to self-insured employer group sponsors for the purpose of enrollment, disenrollment, administration, obtaining premium bids as well modifying amending or terminating group health plans.
  7. Fallon will not disclose PHI to a plan sponsor when Fallon knows the plan sponsor intends to use the PHI to make employment related decisions about individuals.
  8. Fallon and its contracted providers must make reasonable effort to limit uses and disclosure of PHI to the minimum necessary to accomplish a legitimate business purpose.