Letter to members template

1up recommends tailoring the template below to meet your needs before publishing in member communications.

Subject: You're in control of how your health information follows you

Dear [Member first name],

When you change health insurance plans, your important health information shouldn't get left behind. The Centers for Medicare and Medicaid Services (CMS) has introduced a new requirement called the Payer-to-payer data exchange, which helps your health data follow you safely when you switch health plans or have more than one plan at the same time.

This secure, electronic data exchange allows health plans to share up to five years of your recent health information with your permission. The goal is to support better care coordination, smoother transitions, and improved continuity of care while keeping your data private and secure.

You're in control

You control whether we request your health care data from your previous insurer or exchange data with your concurrent insurers through the API. By default, you are opted-out so no data is shared. You can opt-in at any time.

When you opt-in, you give your plan permission to securely request and exchange information that supports your ongoing care. You can opt-out again at any time.

Benefits of opting in

Opting into data sharing has several potential benefits including

  • improved completeness of your medical records if you change insurance carriers,

  • reduction in care disruptions,

  • faster approvals for treatments,

  • better coordination between plans.

Your privacy comes first

Your health care data is protected by privacy and security measures. Even if you opt-in your data will not be shared with insurers you are not enrolled with. This API data exhange will only be used to receive data from your previous insurer, exchange data with your concurrent insurer, and send data to your future insurer (as appropriate). You can opt-out at any time if you change your mind.

How to opt-in

{Either choose one of the options below or insert your custom opt-in process. Include only the relevant process choice below by deleting one section entirely and the header (h4) for the chosen section.}

Option 1: Process for members if you (the payer) have configured IdP integration for opt-in

  1. Click on the opt-in link in your member portal.

  2. Review the educational materials presented to you and click Continue.

  3. Choose whether you would like to Opt-in or Opt-out of the Payer to Payer Data Exchange then click Next. If you choose to Opt-in continue to the next step. If you choose to Opt-out you may return to your member portal.

  4. Search for your health plan and select it. You can manually enter your health plan's information if you don't see it in the search results.

  5. Enter your Member ID for that health plan.

  6. Select the year your coverage with that health plan ended or will end.

  7. Repeat steps 4 through 6 until you have selected all the health plans that you want to request data from.

  8. Click Confirm. A confirmation page is displayed to let you know that you have opted-in successfully.

Option 2: Process for members if you (the payer) have not configured IdP integration but still use 1upHealth for opt-in

  1. Click on the opt-in link in your member portal.

  2. Click Register.

  3. Enter the information required to create an account and click Register.

  4. Review the educational materials presented to you and click Continue.

  5. Choose whether you would like to Opt-in or Opt-out of the Payer to Payer Data Exchange then click Next. If you choose to Opt-in continue to the next step. If you choose to Opt-out you may return to your member portal.

  6. Search for your health plan and select it. You can manually enter your health plan's information if you don't see it in the search results.

  7. Enter your Member ID for that health plan.

  8. Select the year your coverage with that health plan ended or will end.

  9. Repeat steps 6 through 8 until you have selected all the health plans that you want to request data from.

  10. Click Confirm. A confirmation page is displayed to let you know that you have opted-in successfully.

Once you opt-in, no further action is required. Your health data will be securely shared between plans using nationally recognized standards.

If you have any questions or need help opting-in or out, please contact our member services team at [Health plan phone number] or [Member support email}.

Thank you for being a valued member.

Optional add-on: short compliance footer

This communication is provided in accordance with the CMS Interoperability and Patient Access Final Rule (CMS-0057-F). Your participation in the Payer-to-Payer Data Exchange is voluntary and can be changed at any time. Data sharing is performed only with your authorization and in compliance with federal privacy and security standards.