S.C. Code Regs. 69-58.18 - When Authorization Required for Disclosure of Nonpublic Personal Health Information
A. 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.
B. 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; ratemaking 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; 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 Director to the extent they are necessary for appropriate performance of
insurance functions and are fair and reasonable to the interest of
consumers.
Notes
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