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This notice describes our legal obligation to comply with HIPAA Privacy and Security laws. We are committed to protect the confidentiality of your healthcare information in our possession. Protected Health Information (PHI) is defined as individually identifiable information regarding a patient’s health care history, and mental or physical condition or treatment. Some examples of PHI include your name, address, telephone and/or fax number, electronic mail address, social security number or other identification number, date of birth, date of treatment, treatment records, x-rays, enrollment and claims records. We receive, use and disclose your PHI to administer your benefit plan, or as permitted or required by law. Any other disclosure of your PHI without your authorization is prohibited.
If you have any questions about this Notice or about our privacy practices, please contact the Member Support Team at (877) 247-8817.
Uses and disclosures of your PHI for treatment, payment or health care operations:
Your explicit authorization is not required to disclose information about yourself for purposes of health care treatment, payment of claims, billing of premiums, and other health care operations.
If your benefit plan is sponsored by another party, we may provide PHI to your plan sponsor to administer your benefits. As permitted by law, we may disclose PHI to third-party affiliates that perform services to administer your benefits, and who have signed a contract agreeing to protect the confidentiality of your PHI, and have implemented privacy policies and procedures that comply with applicable federal and state laws.
Some examples of disclosure, and use for treatment, payment, or operations, include: processing your claims, collecting enrollment information and premium payments, reviewing the quality of health care you receive, providing customer service, and resolving grievances.
We may contract with individuals or entities known as Business Associates to perform various functions on our behalf or to provide certain types of services. In order to perform these functions or to provide these services, Business Associates will receive, create, maintain, use and/or disclose your protected health information, but only after they agree in writing with us to implement appropriate safeguards regarding your protected health information. For example, we may disclose your protected health information to a Business Associate, but only after the Business Associate enters into a Business Associate Agreement with us.
We are permitted to disclose your PHI upon your request, or to your authorized personal representative (with certain exceptions), when required by the U. S. Secretary of Health and Human Services to investigate or determine our compliance with the law, and when otherwise required by law. We may disclose your PHI without your prior authorization in response to the following:
We do not use, disclose, sell or transfer any personal information without consent unless required or permitted by law or regulation. In cases of permitted disclosure, we will disclose information in compliance with applicable laws and regulations and will require the recipient to protect the information and use it only for the purpose provided.
When you request, we are required to disclose to you the portion of your protected health information that contains medical records, billing records, and any other records used to make decisions regarding your health care benefits.
Right to Inspect and Copy. You have the right to inspect and copy certain PHI that may be used to make decisions about your Plan benefits.
Right to Amend. If you feel that your PHI is incorrect or incomplete, you may ask to amend the information. You have the right to request an amendment for as long as the information is kept by or for the Plan. Your request may be denied if it is not part of the information that you would be permitted to inspect and copy; or is already accurate and complete.
Right to Be Notified of a Breach in the event that the Plan Sponsor (or a Business Associate) discover a breach of unsecured PHI.
Changes to our Notice of Privacy Policy and Insurance Information Practices
This statement may be updated; when updates are made, the revision date will updated to reflect that a revision occurred. This statement is not intended to and does not create any contractual or other legal rights in or on behalf of any party.
Last revision: February 8, 2023