Page 19 - 2016 WFF Guide 1
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T o F i n d O ut W hat D i sc losures H av e B een M ade: you hav e a right to get The Plan’s Deputy Privacy Oficial(s) Is/
a list of w hen, to w hom, for w hat purpose, and w hat portion of your P H I has A re:
been released by the P lan and its v end ors, other than instances of d isclosure for
w hich you gav e authoriz ation, or instances w here the d isclosure w as mad e to Beneits Administrator
you or your family. I n ad d ition, the d isclosure list w ill not includ e d isclosures for 3 1 4 .5 8 4 .6 6 2 9
treatment, payment, or health care operations. The list also w ill not includ e any
disclosures made for national security purposes, to law enforcement oficials or O rganiz ed H ealth C are
correctional facilities, or before the d ate the fed eral priv acy rules applied to the A rrangement D esignation
P lan. Y ou w ill normally receiv e a response to your w ritten req uest for such a list
w ithin 6 0 d ays after you mak e the req uest in w riting. Y our req uest can relate to The P lan participates in w hat the fed eral
d isclosures going as far back as six years. There w ill be no charge for up to one priv acy rules call an “ O rganiz ed H ealth
such list each year. There may be a charge for more freq uent req uests. C are A rrangement.” The purpose of that
participation is that it allow s P H I to be
H ow to C omplain A bout the P lan’ s P riv acy P ractices
shared betw een the members of the
I f you think the P lan or one of its v end ors may hav e v iolated your priv acy rights, or A rrangement, w ithout authoriz ation by
if you d isagree w ith a d ecision mad e by the P lan or a v end or about access to your the persons w hose P H I is shared , for
PHI, you may ile a complaint with the person listed in the section immediately below. health care operations. P rimarily, the
You also may ile a written complaint with the Secretary of the U.S. Department of d esignation is useful to the P lan because
H ealth and H uman S erv ices. The law d oes not permit anyone to tak e retaliatory action it allow s the insurers w ho participate in
against you if you mak e such complaints. the A rrangement to share P H I w ith the
N otification of a P riv acy B reach P lan for purposes such as shopping for
other insurance bid s.
A ny ind iv id ual w hose unsecured P H I has been, or is reasonably believ ed to hav e been
used , accessed , acq uired or d isclosed in an unauthoriz ed manner w ill receiv e w ritten The members of the O rganiz ed H ealth
notiication from the Plan within 60 days of the discovery of the breach. C are A rrangement are:
I f the breach inv olv es 5 0 0 or more resid ents of a state, the P lan w ill notify prominent The C ompany M ed ical P lan,
med ia outlets in the state. The P lan w ill maintain a log of security breaches and w ill A nthem
report this information to H H S on an annual basis. I mmed iate reporting from the P lan The C ompany D ental C are P lan,
to H H S is req uired if a security breach inv olv es 5 0 0 or more people. U nited H ealthcare
The C ompany V ision P lan,
C ontact P erson for I nformation, or to S ubmit a C omplaint U nited H ealthcare
If you have questions about this Notice please contact the Plan’s Privacy Oficial or
Deputy Privacy Oficial(s) (see below). If you have any complaints about the Plan’s E ffectiv e D ate: the effectiv e d ate of this N otice
privacy practices, handling of your PHI, or breach notiication process, please contact is: O ctober, 2 0 1 5 .
the Privacy Oficial or an authorized Deputy Privacy Oficial.
P riv acy O fficial
The Plan’s Privacy Oficial, the Person Responsible for Ensuring Compliance with This
N otice, I s:
Beneits Administrator
3 1 4 .5 8 4 .6 6 2 9
2016 Open Enrollment
T o F i n d O ut W hat D i sc losures H av e B een M ade: you hav e a right to get The Plan’s Deputy Privacy Oficial(s) Is/
a list of w hen, to w hom, for w hat purpose, and w hat portion of your P H I has A re:
been released by the P lan and its v end ors, other than instances of d isclosure for
w hich you gav e authoriz ation, or instances w here the d isclosure w as mad e to Beneits Administrator
you or your family. I n ad d ition, the d isclosure list w ill not includ e d isclosures for 3 1 4 .5 8 4 .6 6 2 9
treatment, payment, or health care operations. The list also w ill not includ e any
disclosures made for national security purposes, to law enforcement oficials or O rganiz ed H ealth C are
correctional facilities, or before the d ate the fed eral priv acy rules applied to the A rrangement D esignation
P lan. Y ou w ill normally receiv e a response to your w ritten req uest for such a list
w ithin 6 0 d ays after you mak e the req uest in w riting. Y our req uest can relate to The P lan participates in w hat the fed eral
d isclosures going as far back as six years. There w ill be no charge for up to one priv acy rules call an “ O rganiz ed H ealth
such list each year. There may be a charge for more freq uent req uests. C are A rrangement.” The purpose of that
participation is that it allow s P H I to be
H ow to C omplain A bout the P lan’ s P riv acy P ractices
shared betw een the members of the
I f you think the P lan or one of its v end ors may hav e v iolated your priv acy rights, or A rrangement, w ithout authoriz ation by
if you d isagree w ith a d ecision mad e by the P lan or a v end or about access to your the persons w hose P H I is shared , for
PHI, you may ile a complaint with the person listed in the section immediately below. health care operations. P rimarily, the
You also may ile a written complaint with the Secretary of the U.S. Department of d esignation is useful to the P lan because
H ealth and H uman S erv ices. The law d oes not permit anyone to tak e retaliatory action it allow s the insurers w ho participate in
against you if you mak e such complaints. the A rrangement to share P H I w ith the
N otification of a P riv acy B reach P lan for purposes such as shopping for
other insurance bid s.
A ny ind iv id ual w hose unsecured P H I has been, or is reasonably believ ed to hav e been
used , accessed , acq uired or d isclosed in an unauthoriz ed manner w ill receiv e w ritten The members of the O rganiz ed H ealth
notiication from the Plan within 60 days of the discovery of the breach. C are A rrangement are:
I f the breach inv olv es 5 0 0 or more resid ents of a state, the P lan w ill notify prominent The C ompany M ed ical P lan,
med ia outlets in the state. The P lan w ill maintain a log of security breaches and w ill A nthem
report this information to H H S on an annual basis. I mmed iate reporting from the P lan The C ompany D ental C are P lan,
to H H S is req uired if a security breach inv olv es 5 0 0 or more people. U nited H ealthcare
The C ompany V ision P lan,
C ontact P erson for I nformation, or to S ubmit a C omplaint U nited H ealthcare
If you have questions about this Notice please contact the Plan’s Privacy Oficial or
Deputy Privacy Oficial(s) (see below). If you have any complaints about the Plan’s E ffectiv e D ate: the effectiv e d ate of this N otice
privacy practices, handling of your PHI, or breach notiication process, please contact is: O ctober, 2 0 1 5 .
the Privacy Oficial or an authorized Deputy Privacy Oficial.
P riv acy O fficial
The Plan’s Privacy Oficial, the Person Responsible for Ensuring Compliance with This
N otice, I s:
Beneits Administrator
3 1 4 .5 8 4 .6 6 2 9
2016 Open Enrollment
