Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 25 - Privacy Of Consumer Financial And Health Information › Subchapter V - Health Information › Section Ins 25.70 - When authorization required for disclosure of nonpublic personal health information

Current through June 24, 2024
(1) A licensee shall not disclose nonpublic
				personal health information about a consumer or customer unless an
				authorization is obtained from the consumer or customer whose nonpublic
				personal health information is sought to be disclosed or unless disclosure of
				the health information is permitted under ss.
				51.30, or
				146.81
				to
				146.84,
				Stats., or otherwise authorized by law.
(2) Nothing in this section shall prohibit,
				restrict or require an authorization for the disclosure of nonpublic personal
				health information by a licensee for the performance of the following insurance
				functions by or on behalf of the licensee: claims administration; claims
				adjustment and management; detection, investigation or reporting of actual or
				potential fraud, misrepresentation or criminal activity; underwriting; policy
				placement or issuance; loss control; rate-making and guaranty fund functions;
				reinsurance and excess loss insurance; risk management; case management;
				disease management; quality assurance; quality improvement; performance
				evaluation; provider credentialing verification; utilization review; peer
				review activities; actuarial, scientific, medical or public policy research;
				grievance procedures; internal administration of compliance, managerial, and
				information systems; policyholder service functions; auditing; reporting;
				database security; administration of consumer disputes and inquiries; external
				accreditation standards; the replacement of a group benefit plan or workers
				compensation policy or program; workers' compensation premium audits; workers'
				compensation first reports of injury; workers' compensation loss runs;
				activities in connection with a sale, merger, transfer or exchange of all or
				part of a business or operating unit; any activity that permits disclosure
				without authorization pursuant to the federal Health Insurance Portability and
				Accountability Act privacy rules promulgated by the U.S. department of health
				and human services; disclosure that is required, or is one of the lawful or
				appropriate methods, to enforce the licensee's rights or the rights of other
				persons engaged in carrying out a transaction or providing a product or service
				that a consumer requests or authorizes; and any activity otherwise permitted by
				law, required pursuant to governmental reporting authority, or to comply with
				legal process. Additional insurance functions may be added with the approval of
				the commissioner to the extent they are necessary for appropriate performance
				of insurance functions and are fair and reasonable to the interest of
				consumers. A licensee may apply for approval of, and the commissioner may
				approve additional specific insurance functions that are subject to this
				subsection if the commissioner finds inclusion is fair and reasonable to the
				interests of consumers.