AUTHORIZATION FOR USE AND/OR DISCLOSURE
OF PROTECTED HEALTH INFORMATION
Voluntary Participation: You acknowledge that you are voluntarily participating in the HealthIO Practice of Milliman, Inc. (“HealthIO,” "our", “we” or “us”) program and that in doing so you will be providing to HealthIO your biometric and/or longitudinal health data (e.g., body weight, blood pressure, oxygen level, pulse rate, etc.) (your “Protected Health Information” or “PHI”). The HealthIO program is being offered to you through your employer and/or its health plan, your health plan, your provider organization, a community care coordination organization, or another association to which you belong (“Sponsor”).
Authorization for Use/Disclosure of Information: By signing into the HealthIO app (our “App”), continuing to use the HealthIO app and/or participating in the HealthIO program, you voluntarily consent to and authorize HealthIO to use and/or disclose your PHI during the term of this Authorization for the purposes and to the recipients described below.
Purposes and Recipients of PHI: By signing into our App, continuing to use our App and/or participating in the HealthIO program, you authorize us to use and/or disclose your PHI for:
Self-Administered Biometric Monitoring: We may use and/or disclose your PHI in connection with our App and self-monitoring of your own PHI.
Treatment and Monitoring by Self-Selected Individuals or Entities: We may use and/or disclose your PHI to those individuals or entities that you have identified as your healthcare advocates, which may include a physician, nurse, pharmacist or other healthcare provider or administrator providing treatment to you, or a self-selected family member, close friend or neighbor.
Administration and Payment by Your Sponsor: We may use and/or disclose your de-identified information (this is data without any information that links the data to you or identifies you) to allow your Sponsor to administer the HealthIO program. If you wish, however, you can choose to invite your Sponsor as a healthcare advocate. If you do so, your PHI will be shared with your Sponsor. You can make this choice in our App. If you do not choose to invite your Sponsor, your PHI will not be shared with your Sponsor.
Analysis to Improve the HealthIO Services or Programs: We may use and/or disclose your PHI to improve our HealthIO services or programs.
Participation in an Incentive/Rewards Program: We may use your PHI to calculate rewards points. Your name and rewards points may be disclosed to other program participants as part of the incentive/rewards program. If you do not wish to have your name and rewards information disclosed to other program participants, you may opt out of participation in the incentive/rewards program by contacting .
Healthcare Operations of Your Sponsor: We may use and/or disclose your PHI in connection with the health care operations of your Sponsor. Health care operations include, but are not limited to, assessing quality and improvement initiatives and activities, creating and conducting training programs, and applying for accreditation, certification, licensing or credentialing activities.
Legal Compliance: We may use and/or disclose your PHI as required by any applicable state or federal law or regulation, or as ordered by a court of competent jurisdiction.
The following use and/or disclosure is applicable only if you receive treatment from an onsite clinic or other healthcare provide subsidized by your Sponsor:
Treatment and Monitoring by or through an Onsite Clinic: We may use and/or disclose your PHI to those individuals or entities that provide treatment to you through an onsite clinic or other healthcare provider that is subsidized by your Sponsor, which may include a physician, nurse, pharmacist or other healthcare provider or administrator providing treatment to you. Your PHI will be held in strict confidence and will not be shared with your Sponsor unless you choose to invite your Sponsor as a healthcare advocate as discussed above.
Term: By signing into our App, continuing to use our App and/or participating in the HealthIO program, you understand and agree that this Authorization will remain in effect from the date you initially sign into our App until you or your Sponsor cancels your involvement in the HealthIO program, or you revoke this Authorization pursuant to your rights described below.
Right to Revoke: You understand that agreeing to this Authorization is voluntary. You do not have to agree to this Authorization or participate in the HealthIO program; however, if you do not agree to this Authorization, you will not be able to participate in the HealthIO program. Your refusal to agree to this Authorization will not affect your treatment, payment, enrollment or eligibility of benefits provided by or through your Sponsor. If you change your mind, you understand that you can revoke this Authorization by providing a written notice of revocation to HealthIO at the address listed below. The revocation will be effective immediately upon HealthIO’s receipt and processing of your written notice, except that the revocation will not have any effect on any action taken by HealthIO in reliance on this Authorization before HealthIO received and processed your written notice of revocation. You also understand that by revoking your Authorization you will no longer be able to participate in the HealthIO program.
Copy of Authorization: To download a copy of our current Authorization, please visit our website located at http://www.healthio.milliman.com/docs/HIPAA-Authorization (copy and paste into your internet browser). If you would like a copy of the Authorization specifically signed by you, please make a request in writing to: 15800 W. Bluemound Road, Suite #100, Brookfield, WI 53005. Please include your name, address, phone number and associated Sponsor. We may contact you to verify your identity. There may be a fee associated with fulfilling your request..
Questions: You may contact HealthIO for answers to your questions about the privacy of your PHI by contacting email@example.com.
Updates and Changes: We reserve the right to amend the terms of this Authorization to reflect changes in our privacy practices. After such changes, you will be prompted to acknowledge and accept the amended terms. You understand and agree that the new terms and practices, including any updated terms of this Authorization, will apply to all of your PHI, including PHI created, received, used or disclosed prior to the effective date of the updated revision.