Page 30 - 2019 DAN
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COLORADO – Health First Colorado IOWA – Medicaid NEVADA – Medicaid SOUTH CAROLINA – Medicaid
(Colorado’s Medicaid Program) & Notice of Privacy Practices Health care operations include activities by this Plan (and, in
Child Health Plan Plus (CHP+) limited circumstances, by other plans or providers), such as
Health First Colorado Website: https:// Website: Medicaid Website: https://dwss.nv.gov/ Website: https://www.scdhhs.gov Please carefully review this notice. It describes how medical wellness and risk assessment programs, quality assessment
www.healthirstcolorado.com/ http://dhs.iowa.gov/ime/members/med- Medicaid Phone: 1-800-992-0900 Phone: 1-888-549-0820 information about you may be used and disclosed and how and improvement activities, customer service, and internal
Health First Colorado Member Contact icaid-a-to-z/hipp you can get access to this information. grievance resolution. Health care operations also include
Center: Phone: 1-888-346-9562 evaluating vendors; engaging in credentialing, training, and
1-800-221-3943/ State Relay 711 The Health Insurance Portability and Accountability Act of accreditation activities; performing underwriting or premium
CHP+: Colorado.gov/HCPF/Child- 1996 (HIPAA) imposes numerous requirements on the use and rating; arranging for medical review and audit activities; and
Health-Plan-Plus disclosure of individual health information by employer health conducting business planning and development. For example,
CHP+ Customer Service: 1-800-359- plans. This information, known as protected health information
1991/ (PHI), includes almost all individually identiiable health the Plan may use information about your claims to audit the
State Relay 711 information held by a plan — whether received in writing, in an third parties that approve payment for Plan beneits.
KANSAS – Medicaid NEW HAMPSHIRE – Medicaid SOUTH DAKOTA - Medicaid WASHINGTON – Medicaid electronic medium, or as an oral communication. This notice The amount of health information used, disclosed or requested
Website: http://www.kdheks.gov/hcf/ Website: http://www.dhhs.nh.gov/oii/ Website: http://dss.sd.gov Website: http://www.hca.wa.gov/free-or- describes the privacy practices of the BeneitsPlus plan. The will be limited and, when needed, restricted to the minimum
Phone: 1-785-296-3512 documents/hippapp.pdf Phone: 1-888-828-0059 low-cost-health-care/program-adminis- plans covered by this notice may share health information with necessary to accomplish the intended purposes, as deined
tration/premium-payment-program
Phone: 603-271-5218 each other to carry out treatment, payment, or health care under the HIPAA rules. If the Plan uses or discloses PHI for
Phone: 1-800-562-3022 ext. 15473 operations. The BeneitsPlus plans are collectively referred to as underwriting purposes, the Plan will not use or disclose PHI that
KENTUCKY – Medicaid NEW JERSEY – Medicaid and CHIP TEXAS – Medicaid WEST VIRGINIA – Medicaid the Plan in this notice, unless speciied otherwise. is your genetic information for such purposes.
Website: http://chfs.ky.gov/dms/default. Medicaid Website: Website: http://gethipptexas.com/ Website: http://mywvhipp.com/
htm http://www.state.nj.us/humanservices/ Phone: 1-800-440-0493 Toll-free phone: 1-855-MyWVHIPP (1-
Phone: 1-800-635-2570 dmahs/clients/medicaid/ 855-699-8447) The Plan’s duties with respect to health information How the Plan may share your health information with
about you
Medicaid Phone: 609-631-2392 The Plan is required by law to maintain the privacy of your Dentsu Aegis Network (AMA)
CHIP Website: http://www.njfamilycare. health information and to provide you with this notice of the The Plan, or its health insurer or HMO, may disclose your
org/index.html health information without your written authorization to AMA
CHIP Phone: 1-800-701-0710 Plan’s legal duties and privacy practices with respect to your for plan administration purposes. (AMA may need your health
health information. If you participate in an insured plan option, information to administer beneits under the Plan. AMA agrees
LOUISIANA – Medicaid NEW YORK – Medicaid UTAH – Medicaid and CHIP WISCONSIN – Medicaid and CHIP you will receive a notice directly from the Insurer. It’s important not to use or disclose your health information other than as
Website:http://dhh.louisiana.gov/index. Website:https://www.health.ny.gov/ Medicaid Website: https://medicaid.utah. Website:https://www.dhs.wisconsin.gov/ to note that these rules apply to the plan, not AMA as an
cfm/subhome/1/n/331 health_care/medicaid/ gov/ publications/p1/p10095.pdf permitted or required by the Plan documents and by law.
Phone: 1-888-695-2447 Phone: 1-800-541-2831 CHIP Website: http://health.utah.gov/chip Phone: 1-800-362-3002 employer — that’s the way the HIPAA rules work. Different Beneits staff, payroll, and inance are the only AMA employees
policies may apply to other BeneitsPlus plans or to data
Phone: 1-877-543-7669 unrelated to the plans. who will have access to your health information for plan
MAINE – Medicaid NORTH CAROLINA – Medicaid VERMONT– Medicaid WYOMING – Medicaid administration functions.
Website: http://www.maine.gov/dhhs/ Website: https://dma.ncdhhs.gov/ Website: http://www.greenmountaincare. Website: https://wyequalitycare.acs-inc. Here’s how additional information may be shared between the
oi/public-assistance/index.html Phone: 919-855-4100 org/ com/ How the Plan may use or disclose your health information Plan and AMA, as allowed under the HIPAA rules:
Phone: 1-800-442-6003 Phone: 1-800-250-8427 Phone: 307-777-7531 The privacy rules generally allow the use and disclosure of
TTY: Maine relay 711 your health information without your permission (known as an The Plan, or its insurer or HMO, may disclose “summary
MASSACHUSETTS – Medicaid and NORTH DAKOTA – Medicaid VIRGINIA – Medicaid and CHIP authorization) for purposes of health care treatment, payment health information” to AMA, if requested, for purposes of
CHIP activities, and health care operations. Here are some examples obtaining premium bids to provide coverage under the Plan
of what that might entail:
Website: http://www.mass.gov/eohhs/ Website: http://www.nd.gov/dhs/ser- Medicaid Website: http://www.coverva.org/programs_premium_assistance.cfm or for modifying, amending, or terminating the Plan. Summary
gov/departments/masshealth/ vices/medicalserv/medicaid/ Medicaid Phone: 1-800-432-5924 Treatment includes providing, coordinating, or managing health information is information that summarizes participants’
Phone: 1-800-862-4840 Phone: 1-844-854-4825 claims information, from which names and other identifying
CHIP Website: http://www.coverva.org/programs_premium_assistance.cfm health care by one or more health care providers or doctors.
CHIP Phone: 1-855-242-8282 Treatment can also include coordination or management of information have been removed.
MINNESOTA – Medicaid OKLAHOMA – Medicaid and CHIP To see if any other states have added a premium assistance program since care between a provider and a third party, and consultation and The Plan, or its insurer or HMO, may disclose to AMA
July 31, 2018 or for more information on special enrollment rights, contact either: referrals between providers. For example, the Plan may share information on whether an individual is participating in the Plan
Website: http://mn.gov/dhs/people- Website: http://www.insureoklahoma.org U.S. Department of Labor U.S. Department of Health and Human your health information with physicians who are treating you. or has enrolled or disenrolled in an insurance option or HMO
we-serve/seniors/health-care/health- Phone: 1-888-365-3742 Employee Beneits Security Services
care-programs/programs-and-services/ offered by the Plan.
medical-assistance.jsp Administration Centers for Medicare & Medicaid Payment includes activities by this Plan, other plans, or
Services
Phone: 1-800-657-3739 www.dol.gov/agencies/ebsa providers to obtain premiums, make coverage determinations, In addition, you should know that AMA cannot and will not use
1-866-444-EBSA (3272) www.cms.hhs.gov and provide reimbursement for health care. This can include health information obtained from the Plan for any employment-
1-877-267-2323, Menu Option 4, Ext. determining eligibility, reviewing services for medical necessity
61565 related actions. However, health information collected by
or appropriateness, engaging in utilization management AMA from other sources — for example, under the Family and
activities, claims management, and billing; as well as Medical Leave Act, Americans with Disabilities Act, or workers’
performing “behind the scenes” plan functions, such as risk compensation programs — is not protected under HIPAA
adjustment, collection, or reinsurance. For example, the Plan (although this type of information may be protected under
may share information about your coverage or the other federal or state laws).
30 2019 Benefits Enrollment Dentsu Aegis Network 31
(Colorado’s Medicaid Program) & Notice of Privacy Practices Health care operations include activities by this Plan (and, in
Child Health Plan Plus (CHP+) limited circumstances, by other plans or providers), such as
Health First Colorado Website: https:// Website: Medicaid Website: https://dwss.nv.gov/ Website: https://www.scdhhs.gov Please carefully review this notice. It describes how medical wellness and risk assessment programs, quality assessment
www.healthirstcolorado.com/ http://dhs.iowa.gov/ime/members/med- Medicaid Phone: 1-800-992-0900 Phone: 1-888-549-0820 information about you may be used and disclosed and how and improvement activities, customer service, and internal
Health First Colorado Member Contact icaid-a-to-z/hipp you can get access to this information. grievance resolution. Health care operations also include
Center: Phone: 1-888-346-9562 evaluating vendors; engaging in credentialing, training, and
1-800-221-3943/ State Relay 711 The Health Insurance Portability and Accountability Act of accreditation activities; performing underwriting or premium
CHP+: Colorado.gov/HCPF/Child- 1996 (HIPAA) imposes numerous requirements on the use and rating; arranging for medical review and audit activities; and
Health-Plan-Plus disclosure of individual health information by employer health conducting business planning and development. For example,
CHP+ Customer Service: 1-800-359- plans. This information, known as protected health information
1991/ (PHI), includes almost all individually identiiable health the Plan may use information about your claims to audit the
State Relay 711 information held by a plan — whether received in writing, in an third parties that approve payment for Plan beneits.
KANSAS – Medicaid NEW HAMPSHIRE – Medicaid SOUTH DAKOTA - Medicaid WASHINGTON – Medicaid electronic medium, or as an oral communication. This notice The amount of health information used, disclosed or requested
Website: http://www.kdheks.gov/hcf/ Website: http://www.dhhs.nh.gov/oii/ Website: http://dss.sd.gov Website: http://www.hca.wa.gov/free-or- describes the privacy practices of the BeneitsPlus plan. The will be limited and, when needed, restricted to the minimum
Phone: 1-785-296-3512 documents/hippapp.pdf Phone: 1-888-828-0059 low-cost-health-care/program-adminis- plans covered by this notice may share health information with necessary to accomplish the intended purposes, as deined
tration/premium-payment-program
Phone: 603-271-5218 each other to carry out treatment, payment, or health care under the HIPAA rules. If the Plan uses or discloses PHI for
Phone: 1-800-562-3022 ext. 15473 operations. The BeneitsPlus plans are collectively referred to as underwriting purposes, the Plan will not use or disclose PHI that
KENTUCKY – Medicaid NEW JERSEY – Medicaid and CHIP TEXAS – Medicaid WEST VIRGINIA – Medicaid the Plan in this notice, unless speciied otherwise. is your genetic information for such purposes.
Website: http://chfs.ky.gov/dms/default. Medicaid Website: Website: http://gethipptexas.com/ Website: http://mywvhipp.com/
htm http://www.state.nj.us/humanservices/ Phone: 1-800-440-0493 Toll-free phone: 1-855-MyWVHIPP (1-
Phone: 1-800-635-2570 dmahs/clients/medicaid/ 855-699-8447) The Plan’s duties with respect to health information How the Plan may share your health information with
about you
Medicaid Phone: 609-631-2392 The Plan is required by law to maintain the privacy of your Dentsu Aegis Network (AMA)
CHIP Website: http://www.njfamilycare. health information and to provide you with this notice of the The Plan, or its health insurer or HMO, may disclose your
org/index.html health information without your written authorization to AMA
CHIP Phone: 1-800-701-0710 Plan’s legal duties and privacy practices with respect to your for plan administration purposes. (AMA may need your health
health information. If you participate in an insured plan option, information to administer beneits under the Plan. AMA agrees
LOUISIANA – Medicaid NEW YORK – Medicaid UTAH – Medicaid and CHIP WISCONSIN – Medicaid and CHIP you will receive a notice directly from the Insurer. It’s important not to use or disclose your health information other than as
Website:http://dhh.louisiana.gov/index. Website:https://www.health.ny.gov/ Medicaid Website: https://medicaid.utah. Website:https://www.dhs.wisconsin.gov/ to note that these rules apply to the plan, not AMA as an
cfm/subhome/1/n/331 health_care/medicaid/ gov/ publications/p1/p10095.pdf permitted or required by the Plan documents and by law.
Phone: 1-888-695-2447 Phone: 1-800-541-2831 CHIP Website: http://health.utah.gov/chip Phone: 1-800-362-3002 employer — that’s the way the HIPAA rules work. Different Beneits staff, payroll, and inance are the only AMA employees
policies may apply to other BeneitsPlus plans or to data
Phone: 1-877-543-7669 unrelated to the plans. who will have access to your health information for plan
MAINE – Medicaid NORTH CAROLINA – Medicaid VERMONT– Medicaid WYOMING – Medicaid administration functions.
Website: http://www.maine.gov/dhhs/ Website: https://dma.ncdhhs.gov/ Website: http://www.greenmountaincare. Website: https://wyequalitycare.acs-inc. Here’s how additional information may be shared between the
oi/public-assistance/index.html Phone: 919-855-4100 org/ com/ How the Plan may use or disclose your health information Plan and AMA, as allowed under the HIPAA rules:
Phone: 1-800-442-6003 Phone: 1-800-250-8427 Phone: 307-777-7531 The privacy rules generally allow the use and disclosure of
TTY: Maine relay 711 your health information without your permission (known as an The Plan, or its insurer or HMO, may disclose “summary
MASSACHUSETTS – Medicaid and NORTH DAKOTA – Medicaid VIRGINIA – Medicaid and CHIP authorization) for purposes of health care treatment, payment health information” to AMA, if requested, for purposes of
CHIP activities, and health care operations. Here are some examples obtaining premium bids to provide coverage under the Plan
of what that might entail:
Website: http://www.mass.gov/eohhs/ Website: http://www.nd.gov/dhs/ser- Medicaid Website: http://www.coverva.org/programs_premium_assistance.cfm or for modifying, amending, or terminating the Plan. Summary
gov/departments/masshealth/ vices/medicalserv/medicaid/ Medicaid Phone: 1-800-432-5924 Treatment includes providing, coordinating, or managing health information is information that summarizes participants’
Phone: 1-800-862-4840 Phone: 1-844-854-4825 claims information, from which names and other identifying
CHIP Website: http://www.coverva.org/programs_premium_assistance.cfm health care by one or more health care providers or doctors.
CHIP Phone: 1-855-242-8282 Treatment can also include coordination or management of information have been removed.
MINNESOTA – Medicaid OKLAHOMA – Medicaid and CHIP To see if any other states have added a premium assistance program since care between a provider and a third party, and consultation and The Plan, or its insurer or HMO, may disclose to AMA
July 31, 2018 or for more information on special enrollment rights, contact either: referrals between providers. For example, the Plan may share information on whether an individual is participating in the Plan
Website: http://mn.gov/dhs/people- Website: http://www.insureoklahoma.org U.S. Department of Labor U.S. Department of Health and Human your health information with physicians who are treating you. or has enrolled or disenrolled in an insurance option or HMO
we-serve/seniors/health-care/health- Phone: 1-888-365-3742 Employee Beneits Security Services
care-programs/programs-and-services/ offered by the Plan.
medical-assistance.jsp Administration Centers for Medicare & Medicaid Payment includes activities by this Plan, other plans, or
Services
Phone: 1-800-657-3739 www.dol.gov/agencies/ebsa providers to obtain premiums, make coverage determinations, In addition, you should know that AMA cannot and will not use
1-866-444-EBSA (3272) www.cms.hhs.gov and provide reimbursement for health care. This can include health information obtained from the Plan for any employment-
1-877-267-2323, Menu Option 4, Ext. determining eligibility, reviewing services for medical necessity
61565 related actions. However, health information collected by
or appropriateness, engaging in utilization management AMA from other sources — for example, under the Family and
activities, claims management, and billing; as well as Medical Leave Act, Americans with Disabilities Act, or workers’
performing “behind the scenes” plan functions, such as risk compensation programs — is not protected under HIPAA
adjustment, collection, or reinsurance. For example, the Plan (although this type of information may be protected under
may share information about your coverage or the other federal or state laws).
30 2019 Benefits Enrollment Dentsu Aegis Network 31
