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criminal, or administrative proceedings. The Plan may deny • Provide a written statement that the time period for reviewing privacy policies, as described in this notice, at any time and to Advantage Plan (like an HMO or PPO) that offers prescription
your right to access, although in certain circumstances, you may your request will be extended for no more than 30 more days, make new provisions effective for all health information that drug coverage. All Medicare drug plans provide at least a
request a review of the denial. along with the reasons for the delay and the date by which the the Plan maintains. This includes health information that was standard level of coverage set by Medicare. Some plans may
Plan expects to address your request previously created or received, not just health information also offer more coverage for a higher monthly premium.
If you want to exercise this right, your request to the Plan must created or received after the policy is changed. If changes are
be in writing. Within 30 days of receipt of your request (60 days Right to receive an accounting of disclosures of your health made to the Plan’s privacy policies described in this notice, you AMA has determined that the prescription drug coverage
if the health information is not accessible on site), the Plan will information will be provided with a revised privacy notice via email and it offered by the BeneitsPlus Medical Plan is, on average for all
provide you with one of these responses: You have the right to a list of certain disclosures of your health will also be posted on the company intranet. plan participants, expected to pay out as much as standard
• The access or copies you requested information the Plan has made. This is often referred to as an Medicare prescription drug coverage pays and is considered
“creditable” prescription drug coverage. This is important for
• A written denial that explains why your request was denied “accounting of disclosures.” You generally may receive this Complaints the reasons described below.
and any rights you may have to have the denial reviewed or accounting if the disclosure is required by law, in connection with If you believe your privacy rights have been violated or your
ile a complaint public health activities, or in similar situations listed in the table Plan has not followed its legal obligations under HIPAA, you Because your existing coverage is, on average, at least as good
earlier in this notice, unless otherwise indicated below.
• A written statement that the time period for reviewing your may complain to the Plan and to the Secretary of Health and as standard Medicare prescription drug coverage, you can keep
request will be extended for no more than 30 more days, You may receive information on disclosures of your health Human Services. You won’t be retaliated against for iling this coverage and not pay a higher premium (a penalty) if you
along with the reasons for the delay and the date by which information for up to six years before the date of your request. a complaint. To ile a complaint, please put your complaint later decide to enroll in a Medicare drug plan, as long as you
the Plan expects to address your request You do not have a right to receive an accounting of any in writing to the Privacy Oficer as indicated below under later enroll within speciic time periods.
disclosures made in any of these circumstances: “contact.” If your contact complaint pertains to an insured
You may also request your health information be sent to beneit, please contact the person indicated in the notice
another entity or person, so long as that request is clear, • For treatment, payment, or health care operations distributed by the insurance company. Any complaints to
conspicuous and speciic. The Plan may provide you with • To you about your own health information the secretary should be addressed to the Secretary of the
a summary or explanation of the information instead of • Incidental to other permitted or required disclosures US Department of Health and Human Services, Hubert
access to or copies of your health information, if you agree H. Humphrey Building, 200 Independence Avenue, S.W.,
in advance and pay any applicable fees. The Plan also may • Where authorization was provided Washington, D.C. 20201. (You may get additional information
charge reasonable fees for copies or postage. If the Plan • To family members or friends involved in your care (where at www.hhs.gov). The Plan encourages you to express
doesn’t maintain the health information but knows where it is disclosure is permitted without authorization) any concerns you may have regarding the Privacy of your
maintained, you will be informed where to direct your request. information.
• For national security or intelligence purposes or to
If the Plan keeps your records in an electronic format, you may correctional institutions or law enforcement oficials in certain Contact
request an electronic copy of your health information in a form circumstances
and format readily producible by the Plan. You may also request • As part of a “limited data set” (health information that For more information on the Plan’s privacy policies or your
that such electronic health information be sent to another entity excludes certain identifying information) rights under HIPAA, contact
or person, so long as that request is clear, conspicuous, and Director of Beneits
speciic. Any charge that is assessed to you for these copies In addition, your right to an accounting of disclosures to a health Dentsu Aegis Network
must be reasonable and based on the Plan’s cost. oversight agency or law enforcement oficial may be suspended 32 Avenue of Americas, 16 Floor
th
at the request of the agency or oficial. New York, NY 10013
Right to amend your health information that is inaccurate or If you want to exercise this right, your request to the Plan must Important Notice from the BeneitsPlus Program About Your
incomplete be in writing. Within 60 days of the request, the Plan will provide Creditable Prescription Drug Coverage and Medicare
With certain exceptions, you have a right to request that the you with the list of disclosures or a written statement that the
Plan amend your health information in a designated record time period for providing this list will be extended for no more Please read this notice carefully and keep it where you can ind
set. The Plan may deny your request for a number of reasons. than 30 days, along with the reasons for the delay and the date it. This notice has information about your current prescription
For example, your request may be denied if the health by which the Plan expects to address your request. You may drug coverage through the BeneitsPlus program and about
information is accurate and complete, was not created by the make one request in any 12-month period at no cost to you, your options under Medicare’s prescription drug coverage. This
Plan (unless the person or entity that created the information is but the Plan may charge a fee for subsequent requests. You’ll information can help you decide whether you want to join a
no longer available), is not part of the designated record set, be notiied of the fee in advance and have the opportunity to Medicare drug plan. Information about where you can get help
or is not available for inspection (e.g., psychotherapy notes change or revoke your request. to make decisions about your prescription drug coverage is at
or information compiled for civil, criminal, or administrative the end of this notice.
proceedings). Right to obtain a paper copy of this notice from the Plan If neither you nor any of your covered dependents are eligible
If you want to exercise this right, your request to the Plan must upon request for or have Medicare, this notice does not apply to you or your
be in writing, and you must include a statement to support You have the right to obtain a paper copy of this privacy notice dependents, as the case may be. However, you should still
the requested amendment. Within 60 days of receipt of your upon request. Even individuals who agreed to receive this notice keep a copy of this notice in the event you or a dependent
request, the Plan will take one of these actions: electronically may request a paper copy at any time. should qualify for coverage under Medicare in the future.
Please note, however, that later notices might supersede this
• Make the amendment as requested Changes to the information in this notice notice.
• Provide a written denial that explains why your request was
denied and any rights you may have to disagree or ile a The Plan must abide by the terms of the privacy notice currently Medicare prescription drug coverage became available in
complaint in effect. This notice takes effect on September 23, 2013. 2006 to everyone with Medicare. You can get this coverage if
However, the Plan reserves the right to change the terms of its you join a Medicare Prescription Drug Plan or join a Medicare
34 2019 Benefits Enrollment Dentsu Aegis Network 35
your right to access, although in certain circumstances, you may your request will be extended for no more than 30 more days, make new provisions effective for all health information that drug coverage. All Medicare drug plans provide at least a
request a review of the denial. along with the reasons for the delay and the date by which the the Plan maintains. This includes health information that was standard level of coverage set by Medicare. Some plans may
Plan expects to address your request previously created or received, not just health information also offer more coverage for a higher monthly premium.
If you want to exercise this right, your request to the Plan must created or received after the policy is changed. If changes are
be in writing. Within 30 days of receipt of your request (60 days Right to receive an accounting of disclosures of your health made to the Plan’s privacy policies described in this notice, you AMA has determined that the prescription drug coverage
if the health information is not accessible on site), the Plan will information will be provided with a revised privacy notice via email and it offered by the BeneitsPlus Medical Plan is, on average for all
provide you with one of these responses: You have the right to a list of certain disclosures of your health will also be posted on the company intranet. plan participants, expected to pay out as much as standard
• The access or copies you requested information the Plan has made. This is often referred to as an Medicare prescription drug coverage pays and is considered
“creditable” prescription drug coverage. This is important for
• A written denial that explains why your request was denied “accounting of disclosures.” You generally may receive this Complaints the reasons described below.
and any rights you may have to have the denial reviewed or accounting if the disclosure is required by law, in connection with If you believe your privacy rights have been violated or your
ile a complaint public health activities, or in similar situations listed in the table Plan has not followed its legal obligations under HIPAA, you Because your existing coverage is, on average, at least as good
earlier in this notice, unless otherwise indicated below.
• A written statement that the time period for reviewing your may complain to the Plan and to the Secretary of Health and as standard Medicare prescription drug coverage, you can keep
request will be extended for no more than 30 more days, You may receive information on disclosures of your health Human Services. You won’t be retaliated against for iling this coverage and not pay a higher premium (a penalty) if you
along with the reasons for the delay and the date by which information for up to six years before the date of your request. a complaint. To ile a complaint, please put your complaint later decide to enroll in a Medicare drug plan, as long as you
the Plan expects to address your request You do not have a right to receive an accounting of any in writing to the Privacy Oficer as indicated below under later enroll within speciic time periods.
disclosures made in any of these circumstances: “contact.” If your contact complaint pertains to an insured
You may also request your health information be sent to beneit, please contact the person indicated in the notice
another entity or person, so long as that request is clear, • For treatment, payment, or health care operations distributed by the insurance company. Any complaints to
conspicuous and speciic. The Plan may provide you with • To you about your own health information the secretary should be addressed to the Secretary of the
a summary or explanation of the information instead of • Incidental to other permitted or required disclosures US Department of Health and Human Services, Hubert
access to or copies of your health information, if you agree H. Humphrey Building, 200 Independence Avenue, S.W.,
in advance and pay any applicable fees. The Plan also may • Where authorization was provided Washington, D.C. 20201. (You may get additional information
charge reasonable fees for copies or postage. If the Plan • To family members or friends involved in your care (where at www.hhs.gov). The Plan encourages you to express
doesn’t maintain the health information but knows where it is disclosure is permitted without authorization) any concerns you may have regarding the Privacy of your
maintained, you will be informed where to direct your request. information.
• For national security or intelligence purposes or to
If the Plan keeps your records in an electronic format, you may correctional institutions or law enforcement oficials in certain Contact
request an electronic copy of your health information in a form circumstances
and format readily producible by the Plan. You may also request • As part of a “limited data set” (health information that For more information on the Plan’s privacy policies or your
that such electronic health information be sent to another entity excludes certain identifying information) rights under HIPAA, contact
or person, so long as that request is clear, conspicuous, and Director of Beneits
speciic. Any charge that is assessed to you for these copies In addition, your right to an accounting of disclosures to a health Dentsu Aegis Network
must be reasonable and based on the Plan’s cost. oversight agency or law enforcement oficial may be suspended 32 Avenue of Americas, 16 Floor
th
at the request of the agency or oficial. New York, NY 10013
Right to amend your health information that is inaccurate or If you want to exercise this right, your request to the Plan must Important Notice from the BeneitsPlus Program About Your
incomplete be in writing. Within 60 days of the request, the Plan will provide Creditable Prescription Drug Coverage and Medicare
With certain exceptions, you have a right to request that the you with the list of disclosures or a written statement that the
Plan amend your health information in a designated record time period for providing this list will be extended for no more Please read this notice carefully and keep it where you can ind
set. The Plan may deny your request for a number of reasons. than 30 days, along with the reasons for the delay and the date it. This notice has information about your current prescription
For example, your request may be denied if the health by which the Plan expects to address your request. You may drug coverage through the BeneitsPlus program and about
information is accurate and complete, was not created by the make one request in any 12-month period at no cost to you, your options under Medicare’s prescription drug coverage. This
Plan (unless the person or entity that created the information is but the Plan may charge a fee for subsequent requests. You’ll information can help you decide whether you want to join a
no longer available), is not part of the designated record set, be notiied of the fee in advance and have the opportunity to Medicare drug plan. Information about where you can get help
or is not available for inspection (e.g., psychotherapy notes change or revoke your request. to make decisions about your prescription drug coverage is at
or information compiled for civil, criminal, or administrative the end of this notice.
proceedings). Right to obtain a paper copy of this notice from the Plan If neither you nor any of your covered dependents are eligible
If you want to exercise this right, your request to the Plan must upon request for or have Medicare, this notice does not apply to you or your
be in writing, and you must include a statement to support You have the right to obtain a paper copy of this privacy notice dependents, as the case may be. However, you should still
the requested amendment. Within 60 days of receipt of your upon request. Even individuals who agreed to receive this notice keep a copy of this notice in the event you or a dependent
request, the Plan will take one of these actions: electronically may request a paper copy at any time. should qualify for coverage under Medicare in the future.
Please note, however, that later notices might supersede this
• Make the amendment as requested Changes to the information in this notice notice.
• Provide a written denial that explains why your request was
denied and any rights you may have to disagree or ile a The Plan must abide by the terms of the privacy notice currently Medicare prescription drug coverage became available in
complaint in effect. This notice takes effect on September 23, 2013. 2006 to everyone with Medicare. You can get this coverage if
However, the Plan reserves the right to change the terms of its you join a Medicare Prescription Drug Plan or join a Medicare
34 2019 Benefits Enrollment Dentsu Aegis Network 35
