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.
This notice is required by the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. If you have any questions about this notice, please contact the Plan’s Privacy Officer (see “Contact Person” on page 78 of the Summary Plan Description).
Your Rights
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get a copy of health and claims records
- You can ask to see or get a copy of your health and claims records and other health information the Plan has about you.
- A request to see or copy your health information records must be made in writing to the Privacy Officer at the address below.
- We will provide a copy or a summary of your records, usually within 30 days of your request. The Plan may charge a reasonable, cost-based fee.
Ask us to correct health and claims records
- You can ask us to correct your health and claims records if you think they are incorrect or incomplete.
- A request for an amendment of records must be made in writing to the Privacy Officer at the address below. Requests must include a reason to support the amendment.
- We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications
- You can ask us to contact you in a specific way (for example, home or office phone or email) or to send mail to a different address.
- We will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not.
- If you wish to receive confidential communications, please make your request in writing to the Privacy Officer at the address below.
Ask us to limit what we use or share
- You can ask us not to use or share certain health information for treatment, payment, of our operations.
- We are not required to agree to your request, and we may say “no” if it would affect your care.
- If you wish to make a request for restrictions, please make your request in writing to the Privacy Officer at the address below.
Get a list of those with whom we’ve shared information
- You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make).
- Please make your request in writing to the Privacy Officer at the address below. The request should specify the time period for which you are requesting the information. Accounting requests may not be made for periods of time going back more than six (6) years. We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months. We will inform you in advance of the fee, if applicable.
Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly. To obtain a paper copy, please contact the Privacy Officer at the address below or by telephone, 410-850-8605.
Choose someone to act for you
- If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
- We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
- You can complain if you believe your privacy rights have been violated. Any complaints to the Plan should be made in writing to the Privacy Officer at the address below. We encourage you to express any concerns you may have regarding the privacy of your health information.
- You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
- We will not retaliate against you for filing a complaint.
Your Choices
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
- Share information with your family, close friends, or others involved in payment for your care
- Share information in a disaster relief situation
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases we never share your information unless you give us written permission:
- Marketing purposes
- Sale of your information
Our Uses and Disclosures
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
Help manage the health care treatment you receive
We can use your health information and share it with professionals who are treating you.
Example: A doctor sends us information about your diagnosis and treatment plan so we can arrange additional services.
Make or obtain payment for your health services
We may use or disclose your health information to make payment to or collect payment from third parties, such as other health plans or providers, for the care you receive.
Example: The Plan may provide information regarding your coverage or health care treatment to other health plans to coordinate payment of benefits.
Operate and administer the Plan
- We can use and disclose your information to run the Plan and contact you when necessary.
- We do not use or disclose any genetic information for underwriting purposes.
Example: We may use your health information to conduct case management, quality improvement, and health plan performance review, provider credentialing activities, or to engage in customer service and grievance resolution activities.
Disclose for Plan Board of Trustees functions
The Plan may disclose your health information to the Plan’s Board of Trustees (the “Board”) for plan administration functions performed by the Board on behalf of the Plan. In addition, the Plan may provide summary health information to the Board so that the Board may solicit premium bids from health insurers, or modify, amend or terminate the Plan. The Plan also may disclose to the Board information on whether you are participating in the Plan.
How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html
Help with public health and safety issues
We can share health information about you for certain situations such as:
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medications
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to anyone’s health or safety
Do research
We can use or share your information for health research, subject to special procedures intended to protect the privacy of your information.
Comply with the law
We will share information about you if federal, state, or local laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Respond to organ and tissue donation requests and work with a medical examiner or funeral director
- We can share health information about you with organ procurement organizations.
- We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:
- For workers’ compensation claims
- For law enforcement purposes or with a law enforcement official
- With health oversight agencies for activities authorized by law
- For special government functions such as military, national security, and presidential protective services
Respond to lawsuits and legal actions
As permitted or required by law, we can share health information about you in response to:
- A court or administrative order as expressly authorized by such order. Records received from a substance use disorder treatment program, or testimony relaying the content of such records, may not be used or disclosed in a civil, criminal, administrative, or legislative proceeding against you unless based on either your written consent, or a valid court order or subpoena, provided you receive notice of and an opportunity to contest such disclosure.
- A subpoena, discovery request or other lawful process, but only when reasonable efforts have been made to either notify you about the request or to obtain an order protecting your health information
Our Responsibilities
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this notice and give you a copy of it.
- We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, on our web site, and we will mail a copy to you.
Contact Person
The Plan has designated a Privacy Officer as its contact person for all issues regarding patient privacy and your privacy rights. You may contact this person’s direct telephone line, 410-850-8605, or in writing at the Plan’s address 700 Maritime Boulevard, Suite A, Linthicum Heights, MD 21090-1996.