Disclosures to Plan Sponsor Sample Clauses

Disclosures to Plan Sponsor. MSI may provide to Sponsor, in its capacity as Sponsor, only aggregate data and other reasonably requested information that does not identify either services received by or the medical condition of individual Covered Employees, and that is not otherwise "Protected Health Information" or ("PHI") as that term is defined under HIPAA. However, if the data or information requested identifies either services received by or the medical condition of an individual Covered Employee, or is otherwise PHI, then release by MSI to Sponsor is subject to the following:

Disclosures to Plan Sponsor. In accordance with HIPAA, the Plan may disclose summary health information to the Plan Sponsor as requested by the Plan Sponsor to allow it to modify, amend or terminate the Plan, or obtain premium bids from insurers to provide health insurance coverage under the Plan. The Plan may disclose to the Plan Sponsor information on whether an individual is participating or enrolled in the Plan. In addition, the Plan may disclose protected health information to the Plan Sponsor as necessary to allow the Plan Sponsor to perform plan administration functions, as used within the meaning of the HIPAA privacy regulations, including the following functions: (1) Collection of individual premiums or contributions; (2) Conducting quality assessment and improvement activities, population- based activities relating to improving health or reducing health care costs, protocol development, case management and care coordination, and related functions; (3) Reviewing health plan performance; (4) Activities relating to obtaining or renewing health insurance or determining premium pricing for such benefits, or placing a contract for reinsurance of risk relating to such claims; (5) Conducting or arranging for medical review, legal services, and auditing functions, including fraud and abuse detection and compliance programs; (6) Business planning and development of the Plan, such as conducting cost- management and planning-related analyses, including formulary development and administration, development or improvement of methods of payment or coverage policies; (7) Business management and general administrative activities of the Plan; (8) Determination of eligibility or coverage (including coordination of benefits or the determination of cost sharing amounts), and adjudication or subrogation of benefit claims; (9) Billing, claims management, collection activities, and related health care data processing; (10) Review of health care services with respect to medical necessity, coverage under a health plan, appropriateness of care or justification of charges; (11) Utilization review activities; (12) Disclosure to consumer reporting agencies of any of the following protected health information relating to collection of premiums or reimbursement: (A) Name and address; (B) Date of birth; (C) Social security number; (D) Payment history; (E) Account number; (F) Name and address of the health care provider and/or health plan; and (13) Risk adjusting amounts due to enrollee health status and dem...