HIPAA Notice of Patient Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Plan Responsibilities

The Plan is required by law to maintain the privacy of your personal health information and to provide you with this notice of our privacy practices and legal duties. The Plan reserves the right to change or amend the terms of this notice and to make any new provisions effective to all of the personal health information that the Plan maintains about you. If this notice is revised, you will be provided with a revised notice.

Your Rights

You have a right to know how the Plan may use or disclose your personal health information. There are certain uses and disclosures of your personal health information that the Plan is permitted or required to make by law without your permission. For all other uses and disclosures, the Plan must first obtain your permission. In addition, you have the following rights:

The right to request that additional restrictions be placed on the Plan’s disclosures of your personal health information. However, the Plan is not required to agree to any such restrictions that you may request.

The right to access, inspect and copy your personal health information the Plan maintains in its files about you. You also have the right to have the Plan correct or amend any information that contains an error. Requests to access or amend your personal health information should be provided to the contact person provided in this notice.

The right to receive an accounting of the disclosures of your personal health information that the Plan makes for purposes other than activities related to your treatment, or the Plan’s payment functions or other health care operations.

The right to request that you receive communications of personal health information in a confidential manner.

 Uses and Disclosures of Personal Health Information

The Plan may use and disclose personal health information for the following purposes, without your permission:

To carry out treatment functions, such as to health care providers to provide you with treatment.

To carry out payment functions, such as those activities related to fulfilling the Plan’s responsibilities for coverage and providing you benefits under the Plan. Such activities may include, but are not limited to reviewing health care services with respect to medical necessity, coverage under the policy, appropriateness of care, or justification of charges.

To carry out health care operations, such as those activities related to carrying out the Plan’s business functions. These activities may include, but are not limited to, reviewing the competence of qualifications of health care professionals, conducting quality assessment activities, amending, replacing or adding benefits, and placing contracts for stop-loss insurance or reinsurance.

To business associates, such as service providers that the Plan has contracted with to perform various functions, such as administrative functions to pay your medical claims. Such business associates are required by law to agree in writing to contract terms requiring the business associate to appropriately safeguard your information.

In situations permitted or required by law, including but not limited to the following:

• As authorized by and to the extent necessary to comply with worker’s compensation or other no-fault laws.
• To a health oversight agency for activities including audits or civil, criminal or administrative proceedings.
• To a public health authority for purposes of public health activities (such as the Food and Drug Administration to report consumer product defects).
• To a law enforcement official for law enforcement purposes or in response to a court order or in the course of any judicial or administrative proceeding.
• To organ procurement organizations, or to other entities for approved research purposes.
• To a government authority, including a social service or protective services agency, authorized to receive reports of abuse, neglect or domestic violence.
• To avert a serious threat to someone’s health or safety.

Purposes to Which You Have Not Objected

In certain limited circumstances, the Plan may use or disclose your personal health information after the Plan has given you an opportunity to object and you have failed to do so.

Written Authorization

All other uses or disclosures of your personal health information will be made only with your written authorization, and any authorization that you give the Plan may be revoked by you at any time.

Complaints

You may complain either directly to the Plan or to the Secretary of Health and Human Services if you believe that your rights with respect to the protection of your personal health information have been violated. To file a complaint with the Plan, you may submit a statement, in writing that includes as many details as possible (including names and dates, where relevant). The complaint should be filed with the Human Resource Coordinator. You will not be retaliated against in any way for filing a complaint.

Practice Regarding Confidentiality and Security

The Plan restricts access to nonpublic personal information about you to those employees who need to know the information in order to provide the Plan’s products and services to you. The Plan maintains physical, electronic, and procedural safeguards that comply with federal regulations to guard nonpublic personal information.

To Obtain Further Information

To obtain further information about your privacy rights or to file a complaint, please contact Patricia Madaras, Human Resource Coordinator, 708-352-3580, ext. 235.