HEALTH INSURANCE PORTABILITY
AND ACCOUNTABILITY ACT (HIPAA)
NOTICE OF PRIVACY PRACTICES
FOR PROTECTED HEALTH INFORMATION
THIS NOTICE DESCRIBES HOW
MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET
ACCESS TO THIS INFORMATION. THIS NOTICE
OF PRIVACY PRACTICES BECOMES EFFECTIVE ON
At
This
notice explains how we protect personal health information we have about you,
and how we may use and disclose that information to others to administer our
business operations and in other circumstances that are either required or
permitted by law. It also informs you of
your rights with respect to your health information and how you can exercise
those rights. When we talk about
information or Protected Health Information (PHI) in this notice, we mean
individually identifiable health information, which relates to your past,
present, or future health, treatment, or payment for health care services. This information that is collected from you
(for example: name, address, and gender), or received from a health care
provider (for example:
We
are required by law to:
We
reserve the right to change any of our privacy practices and the terms of this
notice, and to make the new notice effective for all Protected Health
Information maintained by us. Once revised, we will make the new notice
available to you and post it on our website.
In cases where state laws further restrict the use or disclosure of the
information described below,
we will follow the provisions of the more stringent state laws.
In
order to administer our health benefit plans effectively, we will collect, use,
and disclose Protected Health Information for the following activities:
Payment: We may use and disclose
your Protected Health Information, as necessary, to determine your eligibility
for benefits and claim administration purposes.
For instance, we may use information regarding services you receive from
health care providers such as physicians, dentists, and hospitals to process
reinsurance. All of these types of uses
are referred to as payment in this notice.
Health
Care Operations: We may use and disclose your
Protected Health Information as necessary, as permitted by law, for our Health
Care Operations which include insurance billing, customer service, coordination
of benefits case management, OSHA compliance, Medical Authority, fraud
prevention and reporting, auditing, collections, and other functions related to
the administration of your insurance payments.
Business
Associates: We may disclose your Protected Health
Information to outside persons or organizations that assist us with our Health
Care Operations (for example collections and auditing). These persons or organizations are our
business associates and we contractually require them to appropriately
safeguard the privacy of your Protected Health Information. We will not share your information with these
groups or individuals unless they agree to keep it protected.
Others
Involved in Your Care: Unless you object by notifying
us in writing at the address enclosed with this notice, we may disclose your
Protected Health Information to family members or others that you have
identified as being involved in your care.
Such use will be based on how involved the person is in your care, or
payment that relates to your care. We
also may disclose your information to an entity assisting in a disaster relief
effort so your family may be notified about your condition, status and
location. If you are not present or able
to agree to disclosures about your health information, we may, using our
professional judgment, determine whether the disclosure is in your best
interest.
Other
Ways We May Use or Disclose your Personal Health Information: We are permitted, and in many cases required
by law, to make certain other uses and disclosures of your Protected Health
Information without your permission:
Your
rights are explained below. Any requests
to exercise those rights should be in writing and addressed to our Privacy
Officer at the address provided at the end of this notice.
Right
to Access: You shave the right to copy and/or inspect
Protected Health Information that we retain on your behalf. All requests must be made in writing and
signed by your or your representative.
We may charge a reasonable fee for copies and postage and, in certain
limited cases, we may deny your request. For example, you do not have the right to
access certain types of information, including:
If
we deny your request, we will notify you in writing and may provide you with
the right to have the denial reviewed.
Right
to Request a Restriction: You have the right to ask us
to restrict how we use or disclose your information for treatment, payment, or
health care operations. Such requests
must be detailed, provided in writing, and signed by you or your
representative. Please note that while
we will try to honor your request, we are not required to agree to these
restrictions. We will attempt to
accommodate reasonable requests when appropriate. We retain the right to terminate an agreed-to
restriction by notifying you in writing if we believe such termination is
appropriate. You may also terminate an
agreed-to restriction by sending us a written request to the address provided
below.
Right
to Confidential Communications: If you
believe that a disclosure of all or part of your Protected Health Information
may endanger or cause harm, you have the right to request that we communicate
with you in confidence by alternative means or to alternative locations. We will accommodate reasonable requests.
Right
to Request an Amendment: you have the right to ask us
to correct or amend Protected Health Information we maintain about you if you
believe it is incorrect or incomplete.
Your request must be in writing, must include the reason for your
request, and must be signed by you or your representative. We are not obligated to make all requested
amendments, but we will give each request careful consideration. If we make the requested amendment or
correction, we will notify you. We may
also notify others who work with us and have copies of the information if we
believe such notification is necessary.
If we deny your request we will notify you in writing and you may then
file a written statement of disagreement.
In this case, you may request that your written amendment request, our
written denial, and your statement of disagreement (and our response if
warranted) be included with your information for any future disclosures.
Right
to a Paper Copy of This Notice: You have
the right to a paper copy of this notice.
Contact
us:
231-839-2198
231-839-6101
Complaints: If you believe your privacy rights have been
violated, you may file a complaint with our Privacy Officer at the address
listed above. You may also notify the
Secretary of the US Department of Health and Human Services of your complaint,
in writing, within 180 days of a violation of your rights. We support your right to protect the privacy
of your Protected Health Information and will not retaliate against your for
filing a complaint.