In the course of using this website, you may share information that qualifies as Protected Health Information (“PHI”) under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). PHI is information created or received by us during your use of the site which identifies you, or for which there is a reasonable basis to believe the information can be used to identify you, and that relates to:
- the past, present or future physical or mental health condition of the individual; or
- the provision of health care to the individual; or
- the past, present or future payment for the provision of health care to the individual.
HIPAA, and other related federal and state legislation, defines a set of rules governing how companies maintain the privacy of customers’ PHI. HIPAA also requires that we provide customers with notice of our legal duties and privacy practices with respect to your PHI. This HIPAA Notice describes how we may use and disclose PHI to perform enrollment, claims handling, payment, general insurance operations, and for other purposes that are permitted or required by law.
Uses and Disclosures of PHI with Your Written Authorization
Except as described in the next section of this Notice, we will not use or disclose your PHI for any purpose unless you have signed a form authorizing the use or disclosure. You have the right to revoke that authorization in writing at any time. However, any action already taken by the Plan or others in reliance on the authorization cannot be changed.
Uses and Disclosures of PHI Without Your Written Authorization
For Payment. We may make use of and disclose your PHI without your written authorization as may be necessary for payment purposes. For example, we may use information regarding your medical procedures and treatment to process and pay claims or certify these services are covered under your Plan.
For Administrative Operations. We may make use of and disclose your PHI without your written authorization as necessary for our administrative operations. Administrative operations include our usual business activities, examples of which are management, licensing, peer review, quality improvement and assurance, enrollment, underwriting, reinsurance, compliance, auditing, rating, claims handling, complaint handling and other functions related to your benefits.
To Individuals Involved in Your Care. We may, without your written authorization, for the purposes of treatment, payment, or administrative operations, disclose the fact that you are covered under a plan or that payment has been processed to a family member, other relative, your close personal friend, or any other person you may identify. In these circumstances, we would not disclose any PHI which is not directly relevant to that person’s involvement with your care or with payment for your care.
If you have designated a person to receive information regarding payment of the premium or pay premium via credit card, we may inform that person or credit card facility when your premium has not been paid or received.
We may also disclose limited PHI to a public or private entity that is authorized to assist in disaster relief efforts in order for that entity to locate a family member or other persons that may be involved in some aspect of caring for you.
To Business Associates. Certain aspects and components of our services are performed through contracts with outside persons or organizations. Examples of these may include, but are not limited to insurance agents, financial auditors, reinsurers, legal services, enrollment and billing services, claim payment, and medical management services. We may provide access to your PHI without your written authorization to one or more of these outside persons or organizations who assist with payment or administrative operations. The Sponsor requires these business associates to safeguard the privacy of your information appropriately.
For Other Products and Services. The Sponsor may contact you without your written authorization to provide information regarding upgrades or additional benefits that may be of interest to you. For example, we may use the fact that you currently are insured under a plan for the purpose of communicating to you about changes to the plan or products that could enhance or add value to existing coverage.
For Other Uses and Disclosures. We are permitted or required by law to make some other uses and disclosures of your PHI without your authorization:
- If required by law to a government oversight agency conducting audits, investigations, or civil or criminal proceedings.
- If required to do so by a court or administrative ordered subpoena or discovery request. In most cases, you will have notice of such a release.
- For public health activities, such as required reporting of disease, injury, birth and death and for required public health investigations.
- To law enforcement officials as required by law to report wounds, injuries or crimes.
- As required by law if we suspect child abuse or neglect or if we believe you to be a victim of abuse, neglect or domestic violence.
- To the Food and Drug Administration if necessary to report adverse events, product defects, or to participate in product recalls.
- To coroners and/or funeral directors, consistent with law.
- For a national security or intelligence activity or, if you are a member of the military, as required by the armed forces.
- To workers' compensation agencies if necessary for workers' compensation benefit determination.
Unless otherwise excluded in this Notice, we will not disclose your PHI to any person or entity not specifically mentioned elsewhere in this Notice without your express written authorization.
Your Rights
Right to Inspect and Copy Your PHI. You may have access to our records that contain your PHI in order to inspect and obtain copies of the records. Under limited circumstances, we may deny you access to a portion of your records. If you desire access to your records, please submit a written request to the Privacy Office at the address noted in the Terms of Use Agreement. If you request copies, we may charge you copying and mailing costs.
Right to Amend Your PHI. You have the right to request that we amend your PHI maintained in our records. If you desire to amend these records, please submit an amendment request in writing to the Privacy Office at the address noted in the Terms of Use Agreement. We will comply with your request unless special circumstances apply. If your physician or other health care provider created the information that you desire to amend, you should contact the provider to amend the information.
Right to an Accounting of the Disclosures of Your PHI. Upon request, you may obtain an accounting of certain disclosures of your PHI made by us, excluding disclosures made earlier than six years before the date of your request. If you request an accounting more than once during any 12-month period, we will charge you a reasonable fee for the subsequent accounting statements.
Right to Request Confidential Communications. We will accommodate your reasonable request to receive communications of your PHI from us by alternative means of communication or at alternative locations if the request clearly states that disclosure of that information could endanger you.
Right to Request Restrictions on Use and Disclosure of Your PHI. You restrictions on some of our uses and disclosures of your PHI for medical treatment, payment, or administrative operations by notifying us of your request for a restriction in writing to the Privacy Office at the address noted in the Terms of Use Agreement. Your request must describe in detail the restriction you are requesting. We are not required to agree to your restriction request but will attempt to accommodate your requests. We retain the right to terminate an agreed-to restriction. In the event of a termination of an agreed-to restriction by us, we will notify you of such termination, but the termination will only be effective for PHI we receive after we have notified you of the termination. You also have the right to terminate any agreed-to restriction by contacting us in writing, as indicated above.
Personal Representatives. You may exercise your rights through a personal representative who will be required to produce evidence of his or her authority to act on your behalf. Proof of authority may be made by a notarized power of attorney, a court order of appointment of the person as your legal guardian or conservator, or if you are the parent of a minor child. We reserve the right to deny access to your personal representative.
Right to Receive Paper Copy of this Notice. You may obtain a copy of this Notice. You may obtain a paper copy of this Notice even if you agreed to receive such notice electronically. Please contact us and we will mail it to you.
Subject to Change
We may change the terms of this Notice at any time. If we change this Notice, we may make the new terms effective for all of your PHI that we maintain, including any information we created or received prior to issuing the new notice.
Complaints
If you believe your privacy rights have been violated, you can file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with us, send it in writing to the Privacy Office at the address noted in the Terms of Use Agreement. There will be no retaliation for filing a complaint.