Op10.03-20 Marketing

Complies with the Administrative Requirements of the Health Insurance Portability and Accountability Act of 1996. 45 CFR Section 164.514(e)


The Employee Benefit Plan's marketing activities protect the privacy of Protected Health Information ("PHI") and include provisions for participants to authorize marketing communications.


  • The Employee Benefit Plan obtains the participants' authorization before disclosing PHI to a third party pursuant to an arrangement whereby the Employee Benefit Plan receives remuneration, direct or indirect, in exchange for the disclosure of PHI to a third party so that the third party may make a communication about its products or services to the participant to encourage the participant to purchase or use that product or service.
  • Marketing includes communications that encourage participants to purchase or use a product or service.
  • Marketing does not include:
    • The Employee Benefit Plan's description of a health-related product or service (or payment for such product or service) that the Employee Benefit Plan provides or includes in its plan of benefits, including communications about the Employee Benefit Plan's participating providers or network.
    • The Employee Benefit Plan's description of replacement of or enhancements to a Employee Benefit Plan.
    • The Employee Benefit Plan's description of health-related products or services that are only available to Employee Benefit Plan participants and that are not part of the plan of benefits, but add value to it.
    • Communications for treatment of the participant.
    • Communications for the participant's case management or care coordination, or to direct or recommend treatment alternatives, therapies, Health Care Providers or settings of care.
  • The Employee Benefit Plan obtains the participant’s authorization before using or disclosing their PHI for marketing purposes unless:
    • the marketing communication takes place during a face-to-face encounter; or
    • the marketing communication is a promotional gift of nominal value.
  • If the Employee Benefit Plan uses/discloses targeted communication to individuals based on their health status/condition, the Employee Benefit Plan:
    • Determines prior to making communication that the product or service being marketed may be beneficial to the individual, and
    • The communication explains why the individual was targeted.
  • When authorizations are necessary for marketing, the Employee Benefit Plan discloses on the authorization form whether or not the Employee Benefit Plan receives remuneration from a third party, either direct or indirect.
  • The Employee Benefit Plan does not allow its Business Associates or others to use PHI for their own marketing purposes without obtaining authorizations from the participants that are the subject of the PHI.
  • The Employee Benefit Plan makes reasonable efforts to ensure that individuals who decide to opt out of receiving marketing materials are not sent future communications.

Effective Date: April 14, 2003