Page 31 - 2018 DAN Enrollment
P. 31
COLORADO – Health First Colorado IOWA – Medicaid NEVADA – Medicaid SOUTH CAROLINA – Medicaid
(Colorado’s Medicaid Program) & Notice of Privacy Practices limited circumstances, by other plans or providers), such as
Child Health Plan Plus (CHP+) wellness and risk assessment programs, quality assessment
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 and improvement activities, customer service, and internal
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 grievance resolution. Health care operations also include
Health First Colorado Member Contact icaid-a-to-z/hipp you can get access to this information. evaluating vendors; engaging in credentialing, training, and
Center: Phone: 1-888-346-9562 accreditation activities; performing underwriting or premium
1-800-221-3943/ State Relay 711 The Health Insurance Portability and Accountability Act of rating; arranging for medical review and audit activities; and
CHP+: Colorado.gov/HCPF/Child- 1996 (HIPAA) imposes numerous requirements on the use and conducting business planning and development. For example,
Health-Plan-Plus disclosure of individual health information by employer health the Plan may use information about your claims to audit the
CHP+ Customer Service: 1-800-359- plans. This information, known as protected health information
1991/ (PHI), includes almost all individually identiiable health third parties that approve payment for Plan beneits.
State Relay 711 information held by a plan — whether received in writing, in an The amount of health information used, disclosed or requested
KANSAS – Medicaid NEW HAMPSHIRE – Medicaid SOUTH DAKOTA - Medicaid WASHINGTON – Medicaid electronic medium, or as an oral communication. This notice will be limited and, when needed, restricted to the minimum
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 necessary to accomplish the intended purposes, as deined
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 under the HIPAA rules. If the Plan uses or discloses PHI for
tration/premium-payment-program
Phone: 603-271-5218 each other to carry out treatment, payment, or health care underwriting purposes, the Plan will not use or disclose PHI that
Phone: 1-800-562-3022 ext. 15473 operations. The beneitsPLUS plans are collectively referred to is your genetic information for such purposes.
KENTUCKY – Medicaid NEW JERSEY – Medicaid and CHIP TEXAS – Medicaid WEST VIRGINIA – Medicaid as the Plan in this notice, unless speciied otherwise.
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- How the Plan may share your health information with
Phone: 1-800-635-2570 dmahs/clients/medicaid/ 855-699-8447) The Plan’s duties with respect to health information Dentsu Aegis Network (AMA)
about you
Medicaid Phone: 609-631-2392 The Plan is required by law to maintain the privacy of your The Plan, or its health insurer or HMO, may disclose your
CHIP Website: http://www.njfamilycare. health information and to provide you with this notice of the health information without your written authorization to AMA
org/index.html for plan administration purposes. (AMA may need your health
CHIP Phone: 1-800-701-0710 Plan’s legal duties and privacy practices with respect to your information to administer beneits under the Plan. AMA agrees
health information. If you participate in an insured plan option, not to use or disclose your health information other than as
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 permitted or required by the Plan documents and by law.
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 Beneits staff, payroll, and inance are the only AMA employees
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 who will have access to your health information for plan
policies may apply to other beneitsPLUS plans or to data
Phone: 1-877-543-7669 unrelated to the plans. administration functions.
MAINE – Medicaid NORTH CAROLINA – Medicaid VERMONT– Medicaid WYOMING – Medicaid Here’s how additional information may be shared between the
Website: http://www.maine.gov/dhhs/ Website: https://dma.ncdhhs.gov/ Website: http://www.greenmountaincare. Website: https://wyequalitycare.acs-inc. Plan and AMA, as allowed under the HIPAA rules:
oi/public-assistance/index.html Phone: 919-855-4100 org/ com/ How the Plan may use or disclose your health information
Phone: 1-800-442-6003 Phone: 1-800-250-8427 Phone: 307-777-7531 The privacy rules generally allow the use and disclosure of The Plan, or its insurer or HMO, may disclose “summary
TTY: Maine relay 711 your health information without your permission (known as an health information” to AMA, if requested, for purposes of
MASSACHUSETTS – Medicaid and NORTH DAKOTA – Medicaid VIRGINIA – Medicaid and CHIP authorization) for purposes of health care treatment, payment obtaining premium bids to provide coverage under the Plan
CHIP activities, and health care operations. Here are some examples or for modifying, amending, or terminating the Plan. Summary
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 health information is information that summarizes participants’
gov/departments/masshealth/ vices/medicalserv/medicaid/ Medicaid Phone: 1-800-432-5924 Treatment includes providing, coordinating, or managing claims information, from which names and other identifying
Phone: 1-800-862-4840 Phone: 1-844-854-4825 information have been removed.
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 The Plan, or its insurer or HMO, may disclose to AMA
MINNESOTA – Medicaid OKLAHOMA – Medicaid and CHIP To see if any other states have added a premium assistance program since January care between a provider and a third party, and consultation and information on whether an individual is participating in the Plan
31, 2017, or for more information on special enrollment rights, contact either: referrals between providers. For example, the Plan may share or has enrolled or disenrolled in an insurance option or HMO
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. offered by the Plan.
we-serve/seniors/health-care/health- Phone: 1-888-365-3742 Employee Beneits Security Services
care-programs/programs-and-services/
medical-assistance.jsp Administration Centers for Medicare & Medicaid Payment includes activities by this Plan, other plans, or In addition, you should know that AMA cannot and will not use
Services
Phone: 1-800-657-3739 www.dol.gov/agencies/ebsa providers to obtain premiums, make coverage determinations, health information obtained from the Plan for any employment-
1-866-444-EBSA (3272) www.cms.hhs.gov and provide reimbursement for health care. This can include related actions. However, health information collected by
1-877-267-2323, Menu Option 4, Ext. determining eligibility, reviewing services for medical necessity
61565 or appropriateness, engaging in utilization management AMA from other sources — for example, under the Family and
Current as of August 10, 2017. OMB Control Number 1210-0137 (expires activities, claims management, and billing; as well as Medical Leave Act, Americans with Disabilities Act, or workers’
12/31/2019) compensation programs — is not protected under HIPAA
performing “behind the scenes” plan functions, such as risk (although this type of information may be protected under
adjustment, collection, or reinsurance. For example, the Plan other federal or state laws).
may share information about your coverage or the
Other allowable uses or disclosures of your health
information
Health care operations include activities by this Plan (and, in In certain cases, your health information can be disclosed
30 2018 Benefits Enrollment Dentsu Aegis Network 31
(Colorado’s Medicaid Program) & Notice of Privacy Practices limited circumstances, by other plans or providers), such as
Child Health Plan Plus (CHP+) wellness and risk assessment programs, quality assessment
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 and improvement activities, customer service, and internal
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 grievance resolution. Health care operations also include
Health First Colorado Member Contact icaid-a-to-z/hipp you can get access to this information. evaluating vendors; engaging in credentialing, training, and
Center: Phone: 1-888-346-9562 accreditation activities; performing underwriting or premium
1-800-221-3943/ State Relay 711 The Health Insurance Portability and Accountability Act of rating; arranging for medical review and audit activities; and
CHP+: Colorado.gov/HCPF/Child- 1996 (HIPAA) imposes numerous requirements on the use and conducting business planning and development. For example,
Health-Plan-Plus disclosure of individual health information by employer health the Plan may use information about your claims to audit the
CHP+ Customer Service: 1-800-359- plans. This information, known as protected health information
1991/ (PHI), includes almost all individually identiiable health third parties that approve payment for Plan beneits.
State Relay 711 information held by a plan — whether received in writing, in an The amount of health information used, disclosed or requested
KANSAS – Medicaid NEW HAMPSHIRE – Medicaid SOUTH DAKOTA - Medicaid WASHINGTON – Medicaid electronic medium, or as an oral communication. This notice will be limited and, when needed, restricted to the minimum
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 necessary to accomplish the intended purposes, as deined
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 under the HIPAA rules. If the Plan uses or discloses PHI for
tration/premium-payment-program
Phone: 603-271-5218 each other to carry out treatment, payment, or health care underwriting purposes, the Plan will not use or disclose PHI that
Phone: 1-800-562-3022 ext. 15473 operations. The beneitsPLUS plans are collectively referred to is your genetic information for such purposes.
KENTUCKY – Medicaid NEW JERSEY – Medicaid and CHIP TEXAS – Medicaid WEST VIRGINIA – Medicaid as the Plan in this notice, unless speciied otherwise.
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- How the Plan may share your health information with
Phone: 1-800-635-2570 dmahs/clients/medicaid/ 855-699-8447) The Plan’s duties with respect to health information Dentsu Aegis Network (AMA)
about you
Medicaid Phone: 609-631-2392 The Plan is required by law to maintain the privacy of your The Plan, or its health insurer or HMO, may disclose your
CHIP Website: http://www.njfamilycare. health information and to provide you with this notice of the health information without your written authorization to AMA
org/index.html for plan administration purposes. (AMA may need your health
CHIP Phone: 1-800-701-0710 Plan’s legal duties and privacy practices with respect to your information to administer beneits under the Plan. AMA agrees
health information. If you participate in an insured plan option, not to use or disclose your health information other than as
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 permitted or required by the Plan documents and by law.
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 Beneits staff, payroll, and inance are the only AMA employees
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 who will have access to your health information for plan
policies may apply to other beneitsPLUS plans or to data
Phone: 1-877-543-7669 unrelated to the plans. administration functions.
MAINE – Medicaid NORTH CAROLINA – Medicaid VERMONT– Medicaid WYOMING – Medicaid Here’s how additional information may be shared between the
Website: http://www.maine.gov/dhhs/ Website: https://dma.ncdhhs.gov/ Website: http://www.greenmountaincare. Website: https://wyequalitycare.acs-inc. Plan and AMA, as allowed under the HIPAA rules:
oi/public-assistance/index.html Phone: 919-855-4100 org/ com/ How the Plan may use or disclose your health information
Phone: 1-800-442-6003 Phone: 1-800-250-8427 Phone: 307-777-7531 The privacy rules generally allow the use and disclosure of The Plan, or its insurer or HMO, may disclose “summary
TTY: Maine relay 711 your health information without your permission (known as an health information” to AMA, if requested, for purposes of
MASSACHUSETTS – Medicaid and NORTH DAKOTA – Medicaid VIRGINIA – Medicaid and CHIP authorization) for purposes of health care treatment, payment obtaining premium bids to provide coverage under the Plan
CHIP activities, and health care operations. Here are some examples or for modifying, amending, or terminating the Plan. Summary
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 health information is information that summarizes participants’
gov/departments/masshealth/ vices/medicalserv/medicaid/ Medicaid Phone: 1-800-432-5924 Treatment includes providing, coordinating, or managing claims information, from which names and other identifying
Phone: 1-800-862-4840 Phone: 1-844-854-4825 information have been removed.
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 The Plan, or its insurer or HMO, may disclose to AMA
MINNESOTA – Medicaid OKLAHOMA – Medicaid and CHIP To see if any other states have added a premium assistance program since January care between a provider and a third party, and consultation and information on whether an individual is participating in the Plan
31, 2017, or for more information on special enrollment rights, contact either: referrals between providers. For example, the Plan may share or has enrolled or disenrolled in an insurance option or HMO
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. offered by the Plan.
we-serve/seniors/health-care/health- Phone: 1-888-365-3742 Employee Beneits Security Services
care-programs/programs-and-services/
medical-assistance.jsp Administration Centers for Medicare & Medicaid Payment includes activities by this Plan, other plans, or In addition, you should know that AMA cannot and will not use
Services
Phone: 1-800-657-3739 www.dol.gov/agencies/ebsa providers to obtain premiums, make coverage determinations, health information obtained from the Plan for any employment-
1-866-444-EBSA (3272) www.cms.hhs.gov and provide reimbursement for health care. This can include related actions. However, health information collected by
1-877-267-2323, Menu Option 4, Ext. determining eligibility, reviewing services for medical necessity
61565 or appropriateness, engaging in utilization management AMA from other sources — for example, under the Family and
Current as of August 10, 2017. OMB Control Number 1210-0137 (expires activities, claims management, and billing; as well as Medical Leave Act, Americans with Disabilities Act, or workers’
12/31/2019) compensation programs — is not protected under HIPAA
performing “behind the scenes” plan functions, such as risk (although this type of information may be protected under
adjustment, collection, or reinsurance. For example, the Plan other federal or state laws).
may share information about your coverage or the
Other allowable uses or disclosures of your health
information
Health care operations include activities by this Plan (and, in In certain cases, your health information can be disclosed
30 2018 Benefits Enrollment Dentsu Aegis Network 31
