HealthPlus* Privacy Notice
Effective April 14, 2003
THIS NOTICE DESCRIBES HOW PERSONAL AND MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This notice is required by law to inform you of how we protect the confidentiality of your health care information in our possession. Protected Health Information (PHI) is defined as individually identifiable information regarding your health care history, mental or physical condition or treatment. Examples of PHI include your name, address, telephone and/ or fax number, electronic mail address, sex, Social Security number or other identification number, date of birth, date of treatment, treatment records, enrollment and claims records. We also receive bills, physician reports and other information about your medical care which has PHI. For some health insurance plans, we also may have credit card and/or bank account information that is supplied by you for payment of premiums. We receive, use and disclose your PHI to administer your health insurance plan as permitted or required by law. Any other disclosure of your PHI without your authorization is prohibited.
We care about your privacy, and we guard your information carefully. We follow the privacy practices described in this notice and federal and state privacy requirements that apply to our administration of your health insurance plan, and provide you with this notice of our legal duties and our privacy practices. We protect your oral, written and electronic PHI by requiring our employees to follow specific confidentiality and technology use procedures. These safeguards follow federal and state laws. We keep your PHI safe including maintaining physical safeguards, such as shredding documents and securing buildings; electronic safeguards, such as encryption and monitoring; and procedural safeguards, such as customer authentication procedures, to guard your PHI against unauthorized access or use. We require our employees to protect PHI through written policies and procedures. The policies limit access to PHI to only those employees who need the data to do their job. We will not sell any of your PHI. We will notify you of any breach of unsecured PHI about you as required by federal and state law. Any such notification will be in writing and at the address on file.
The effective date of this notice is April 14, 2003. We are required to follow the terms of this notice until it is replaced. We reserve the right to change the terms of this notice at any time. We reserve the right to make the new changes apply to all of your PHI maintained by us before and after the effective date of the new notice. Any changes to our notice will be published on our website and in our member newsletter.
The following categories describe when we may use or disclose your PHI without your consent or authorization. Each category includes general examples of the type of use or disclosure, but not every use or disclosure that falls within a category will be listed:
Treatment. We may disclose medical information about you for the purpose of coordinating your health care. For example, we may disclose PHI at your doctor’s request to facilitate receipt of treatment.
Payment. We may use and disclose your PHI so that the medical services you receive can be properly billed and paid. For example, we may use or disclose your PHI to determine eligibility or plan responsibility for benefits; confirm enrollment and coverages; facilitate payment for treatment and covered services received; coordinate benefits with other insurance carriers; and adjudicate benefit claims and appeals.
Health care operations. We may need to use and disclose your PHI in connection with our business operations with affiliated entities. For example, we may use or disclose your PHI to conduct quality assessment and improvement activities; underwriting, premium rating or other activities related to creating an insurance contract; data aggregation services; care coordination, case management and customer service; auditing, legal and medical reviews; and to manage, plan or develop our business.
Health services. We, or our business associates, may use your PHI to contact you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.
To business associates. As permitted by law, we may disclose your PHI to business associates that perform services for us in administrative, billing, claims and other matters. Each business associate must agree in writing to protect the confidentiality and security of your PHI, and have implemented privacy policies and procedures that comply with applicable federal and state law.
To plan sponsor. We may disclose to your employer (the Plan Sponsor), in summary form, claims history and other similar information. Such summary information does not disclose your name or other distinguishing characteristics. We may also disclose to the Plan Sponsor that you are enrolled in or disenrolled from your employer health plan (Plan). We may disclose your PHI to the Plan Sponsor for authorized administrative functions that the Plan Sponsor provides for the Plan. The Plan Sponsor will not use or disclose your PHI for employment-related activities or any other benefit plan. We may also disclose your PHI if you are a participant or dependent in a self-funded Plan and the employer has provided us with written assurances that the information will be kept confidential and will not be used for an improper purpose.
As required by law. We may use or disclose your PHI for other important activities permitted or required by state or federal law, with or without your authorization. These include, for example:
We may also use and disclose your PHI information as follows:
We will not use or disclose your PHI for other purposes, unless you give us your written authorization. If you give us written authorization to use or disclose your PHI for a purpose that is not described in this notice, then, in most cases, you may revoke it in writing at any time. Your revocation will be effective for all your PHI we maintain on the date we receive the revocation, unless we have taken action in reliance on your authorization.
You may request in writing that we do the following concerning your PHI that we maintain:
Copies of this notice. You have the right to receive an additional copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. Please call or write to us to request a copy. A copy of this notice is posted on our website.
Your right to inspect and copy. Upon written request, you have the right to inspect the PHI we have about you and to get copies of that information. We will only maintain that PHI that we obtain or utilize in providing your health care benefits. Please be aware that you may need to contact your health care provider to obtain PHI that we do not possess. In limited cases, we are not required to agree to your request.
Your right to amend. If you believe that the PHI we have about you is incorrect or incomplete, you can make a written request to us to amend that PHI. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us, and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. If your PHI was sent to us by another, we may refer you to that person to amend your PHI. For example, we may refer you to your health care provider to amend your treatment chart.
Your right to a list of disclosures. Upon written request, you have the right to receive a list of our disclosures of your PHI, except when you have authorized those disclosures or if the disclosures are made for treatment, payment, health care operations or other exceptions. We are not required to give you a list of disclosures made before April 14, 2003.
Your right to request restrictions on our use or disclosure of information. If you do so in writing, you have the right to request restrictions on the information we may use or disclose about you; however, you may not restrict our legal or permitted uses and disclosures of PHI. While we will consider your request, we are not required to agree to such requests.
Your right to request confidential communications. You have the right to request that we communicate with you about your PHI in a different means or at a different location than we currently do. Your request must be in writing and must specify the alternative means or location to communicate with you. For example, you can ask that we contact you only at home, only at a certain address or only by mail.
If you want to use your rights described in this notice, you may call us or write to us. If your request to us must be in writing, we will help you prepare your written request, if you wish. Any communications must include (1) your name, address, telephone number and identification number, and (2) the PHI at issue or that you are requesting.
If you want to exercise any of your rights under this notice, communicate with us about privacy issues or to file a complaint, you can:
You will not be penalized for filing a complaint.
If you believe that your privacy rights have been violated, you have the right to file a complaint with the federal government.
You will not be penalized for filing a complaint with the federal government.
*When we refer to HealthPlus, we, or our, we mean HealthPlus of Michigan, Inc., and its
affiliated entity, HealthPlus Options, Inc. We are affiliated entities as defined under the
Health Insurance Portability and Accountability Act and related regulations (“HIPAA”) and
we share information among ourselves as appropriate. When we refer to you, we mean a
member of a HealthPlus of Michigan, Inc. and its affiliated entity, HealthPlus Options, Inc.
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