<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".17" citation="COMAR 31.16.08.17" title_num="31" subtitle_num="16" chapter_num="08" heading="When Authorization Required for Disclosure of Nonpublic Personal Health Information.">
  <paragraph num="A.">
    <text>A licensee may 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.</text>
  </paragraph>
  <paragraph num="B.">
    <text>This regulation does not 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:</text>
    <paragraph num="(1)">
      <text>Claims administration;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Claims adjustment and management;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Detection, investigation, or reporting of actual or potential fraud, misrepresentation, or criminal activity;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Underwriting;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Policy placement or issuance;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Loss control;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Rate-making and guaranty fund functions;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Reinsurance and excess loss insurance;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Risk management;</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Case management;</text>
    </paragraph>
    <paragraph num="(11)">
      <text>Disease management;</text>
    </paragraph>
    <paragraph num="(12)">
      <text>Quality assurance;</text>
    </paragraph>
    <paragraph num="(13)">
      <text>Quality improvement;</text>
    </paragraph>
    <paragraph num="(14)">
      <text>Performance evaluation;</text>
    </paragraph>
    <paragraph num="(15)">
      <text>Provider credentialing verification;</text>
    </paragraph>
    <paragraph num="(16)">
      <text>Utilization review;</text>
    </paragraph>
    <paragraph num="(17)">
      <text>Peer review activities;</text>
    </paragraph>
    <paragraph num="(18)">
      <text>Actuarial, scientific, medical, or public policy research;</text>
    </paragraph>
    <paragraph num="(19)">
      <text>Grievance procedures;</text>
    </paragraph>
    <paragraph num="(20)">
      <text>Internal administration of compliance, managerial, and information systems;</text>
    </paragraph>
    <paragraph num="(21)">
      <text>Policyholder service functions;</text>
    </paragraph>
    <paragraph num="(22)">
      <text>Auditing;</text>
    </paragraph>
    <paragraph num="(23)">
      <text>Reporting;</text>
    </paragraph>
    <paragraph num="(24)">
      <text>Database security;</text>
    </paragraph>
    <paragraph num="(25)">
      <text>Administration of consumer disputes and inquiries;</text>
    </paragraph>
    <paragraph num="(26)">
      <text>External accreditation standards;</text>
    </paragraph>
    <paragraph num="(27)">
      <text>The replacement of a group benefit plan or workers' compensation policy or program;</text>
    </paragraph>
    <paragraph num="(28)">
      <text>Activities in connection with a sale, merger, transfer, or exchange of all or part of a business or operating unit;</text>
    </paragraph>
    <paragraph num="(29)">
      <text>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;</text>
    </paragraph>
    <paragraph num="(30)">
      <text>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;</text>
    </paragraph>
    <paragraph num="(31)">
      <text>Any activity otherwise permitted by law, required pursuant to governmental reporting authority, or to comply with legal process; and</text>
    </paragraph>
    <paragraph num="(32)">
      <text>Any additional insurance functions determined by the Commissioner to the extent that they are:</text>
      <paragraph num="(a)">
        <text>Necessary for appropriate performance of insurance functions; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Fair and reasonable to the interest of consumers.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>