Page 32 - Dentons 2021 Benefits Guide Hawaii
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Breach notification requirements. The Plan will comply with the Health Information Technology for Economic
and Clinical Health Act (“HITECH”) and its implementing regulations to provide notification to affected individuals,
HHS and the media (when required) if the Plan or one of its business associates discovers a breach of unsecured PHI.
Your rights regarding PHI the plan maintains
You have the following rights regarding PHI the Plan maintains about you:
Right to inspect and obtain a copy. You have the right to inspect and obtain a copy of certain PHI the Plan maintains
about you, except for psychotherapy notes and other limited exceptions, such as information compiled in anticipation
of or for use in a legal or administrative action. With respect to PHI, the Plan maintains a “designated record set.” A
designated record set means a group of records maintained by or for the Plan such as enrollment, payment, claims
adjudication, and case or medical management record systems; or that is used by or for the Plan to make decisions
about you. You must submit your request in writing to Dentons US Human Resources Department at the address
designated at the end of this Notice. If you request us to provide your PHI to someone other than yourself, you must
clearly identify that person and state where to send the copy of PHI. If you request a copy of the information, a fee
may be charged for the costs of copying, mailing or other supplies associated with your request. In limited cases, the
Plan does not have to agree to your request. If you are denied access to PHI, you may in most instances request that
the denial be reviewed.
Right to amend. You have the right to ask for the amendment of your PHI that is maintained by the Plan in a
“designated record set” (see above definition). Your request must be made in writing and submitted to the Dentons
Human Resources Department at the address designated at the end of this Notice. In addition, you must provide a
reason that supports your request. The Plan may deny your request if not in writing or if it does not contain supporting
reasons. In addition, the Plan may deny your request (1) if the subject of the request is not part of the designated record
set or if you ask to amend information that was not created by the Plan (unless the person or entity that created the
information is no longer available to act on the requested amendment); (2) if the PHI would not otherwise be available
to you for inspection; or (3) if the PHI is accurate and complete. If your request is denied, you will be told why, and
you can submit a statement that you disagree with the denial.
Right to an accounting of disclosures. Except for limited circumstances as defined by HIPAA, you have the right
to request an “accounting of disclosures” made by the Plan. Some, but not all, of the exceptions include where the
disclosure was made by the Plan for treatment, payment, or health care operations, where the disclosure was made to
you or your personal representative or to family, friends, and relatives, or where the disclosure was made pursuant to
your authorization or was incidental to a disclosure otherwise permitted or required. In certain circumstances involving
disclosures to a health oversight agency or law enforcement official, the Plan is required to suspend your right to receive
an accounting. To request an accounting of disclosures, you must submit a written request to the Dentons US Human
Resources Department at the address designated at the end of this Notice. Your request must state a time period which
may not be longer than 6 years and may not include dates before the Plan was subject to HIPAA. The first accounting
that you request within a 12-month period will be free. For subsequent requests within the 12-month period, you may
be charged for the costs of providing the accounting. If a cost will be charged, you will be notified in advance and
given an opportunity to withdraw or modify your request for a subsequent accounting in order to avoid or reduce the
fee.
Right to request restrictions. You have the right to request a restriction or limitation on the PHI that the Plan may
use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit
on the PHI that the Plan can disclose about you to someone who is involved in your care or the payment for your care,
like a family member, relative, or friend. The Plan is not required to agree to your request. If it does agree, the Plan
can still disclose the information if you are in need of emergency treatment. You must request restrictions in writing
and send them to the Dentons Human Resources Department at the address designated at the end of this Notice. In
your request, you must advise the Plan of (1) what information you want to limit; (2) whether you want to limit use,
disclosure, or both; and (3) to whom you want the limits to apply. A restriction that the Plan has agreed to can be
terminated as allowed by HIPAA. Keep in mind that while the Plan is not required to agree to your request as described
above, a provider must agree to restrict disclosure of your PHI to the Plan if the disclosure is for the purpose of carrying
out payment or health care operations, is not otherwise required by law and the PHI pertains solely to a health care
item or service for which you (or someone on your behalf, other than the Plan) has paid in full.
Right to request confidential communications. You have the right to request that you receive communication from
the Plan by alternative means or at alternative locations. The Plan does not have to agree to your request unless the
Plan believes it is reasonable, you clearly state that the confidential communication is necessary to avoid endangering
4
and Clinical Health Act (“HITECH”) and its implementing regulations to provide notification to affected individuals,
HHS and the media (when required) if the Plan or one of its business associates discovers a breach of unsecured PHI.
Your rights regarding PHI the plan maintains
You have the following rights regarding PHI the Plan maintains about you:
Right to inspect and obtain a copy. You have the right to inspect and obtain a copy of certain PHI the Plan maintains
about you, except for psychotherapy notes and other limited exceptions, such as information compiled in anticipation
of or for use in a legal or administrative action. With respect to PHI, the Plan maintains a “designated record set.” A
designated record set means a group of records maintained by or for the Plan such as enrollment, payment, claims
adjudication, and case or medical management record systems; or that is used by or for the Plan to make decisions
about you. You must submit your request in writing to Dentons US Human Resources Department at the address
designated at the end of this Notice. If you request us to provide your PHI to someone other than yourself, you must
clearly identify that person and state where to send the copy of PHI. If you request a copy of the information, a fee
may be charged for the costs of copying, mailing or other supplies associated with your request. In limited cases, the
Plan does not have to agree to your request. If you are denied access to PHI, you may in most instances request that
the denial be reviewed.
Right to amend. You have the right to ask for the amendment of your PHI that is maintained by the Plan in a
“designated record set” (see above definition). Your request must be made in writing and submitted to the Dentons
Human Resources Department at the address designated at the end of this Notice. In addition, you must provide a
reason that supports your request. The Plan may deny your request if not in writing or if it does not contain supporting
reasons. In addition, the Plan may deny your request (1) if the subject of the request is not part of the designated record
set or if you ask to amend information that was not created by the Plan (unless the person or entity that created the
information is no longer available to act on the requested amendment); (2) if the PHI would not otherwise be available
to you for inspection; or (3) if the PHI is accurate and complete. If your request is denied, you will be told why, and
you can submit a statement that you disagree with the denial.
Right to an accounting of disclosures. Except for limited circumstances as defined by HIPAA, you have the right
to request an “accounting of disclosures” made by the Plan. Some, but not all, of the exceptions include where the
disclosure was made by the Plan for treatment, payment, or health care operations, where the disclosure was made to
you or your personal representative or to family, friends, and relatives, or where the disclosure was made pursuant to
your authorization or was incidental to a disclosure otherwise permitted or required. In certain circumstances involving
disclosures to a health oversight agency or law enforcement official, the Plan is required to suspend your right to receive
an accounting. To request an accounting of disclosures, you must submit a written request to the Dentons US Human
Resources Department at the address designated at the end of this Notice. Your request must state a time period which
may not be longer than 6 years and may not include dates before the Plan was subject to HIPAA. The first accounting
that you request within a 12-month period will be free. For subsequent requests within the 12-month period, you may
be charged for the costs of providing the accounting. If a cost will be charged, you will be notified in advance and
given an opportunity to withdraw or modify your request for a subsequent accounting in order to avoid or reduce the
fee.
Right to request restrictions. You have the right to request a restriction or limitation on the PHI that the Plan may
use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit
on the PHI that the Plan can disclose about you to someone who is involved in your care or the payment for your care,
like a family member, relative, or friend. The Plan is not required to agree to your request. If it does agree, the Plan
can still disclose the information if you are in need of emergency treatment. You must request restrictions in writing
and send them to the Dentons Human Resources Department at the address designated at the end of this Notice. In
your request, you must advise the Plan of (1) what information you want to limit; (2) whether you want to limit use,
disclosure, or both; and (3) to whom you want the limits to apply. A restriction that the Plan has agreed to can be
terminated as allowed by HIPAA. Keep in mind that while the Plan is not required to agree to your request as described
above, a provider must agree to restrict disclosure of your PHI to the Plan if the disclosure is for the purpose of carrying
out payment or health care operations, is not otherwise required by law and the PHI pertains solely to a health care
item or service for which you (or someone on your behalf, other than the Plan) has paid in full.
Right to request confidential communications. You have the right to request that you receive communication from
the Plan by alternative means or at alternative locations. The Plan does not have to agree to your request unless the
Plan believes it is reasonable, you clearly state that the confidential communication is necessary to avoid endangering
4
