Page 19 - Flyer Employer Benefits Brochure - Final 2021 w_compliance notices

Respond to organ and tissue donation requests and work with a medical examiner or funeral director

• We can share PHI about you with organ procurement organizations.
• We can share PHI with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests

We can use or share PHI about you:

• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

We can share PHI about you in response to a court or administrative order, or in response to a subpoena.

Communicate with service providers

We may enter into agreements with entities or individuals to provide services (for example, claims processing services)
to the Plan. These service providers, called “business associates,” may create, receive, have access to, use, and/or disclose
(including to other business associates) PHI in conjunction with the services they provide to the Plan, provided that we
have obtained satisfactory written assurances that the business associates will comply with all applicable Privacy Rules.

Our Responsibilities

• We are required by law to maintain the privacy and security of your PHI.
• The Plan must notify you within 60 days of discovery of a breach. A breach occurs if unsecured PHI is acquired, used
or disclosed in a manner that is impermissible under the Privacy Rules, unless there is a low probability that the PHI
has been compromised.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your PHI other than as described here unless you provide written authorization. If you
authorize use or sharing, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see:
www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will
be available upon request, on our web site, and we will provide a copy to you.

No Guarantee of Employment
This notice does not create any right to employment for any individual, nor does it change your employer’s right to discharge
any of its employees at any time, with or without cause.

No Change to Plan Benefits
This notice explains your privacy rights as a current or former participant in the Plan. The Plan is bound by the terms of this
notice as they relate to the privacy of your PHI. However, this notice does not change any other rights or obligations you may
have under the Plan. You should refer to the Plan documents for additional information regarding your Plan benefits.

Compliance with State Privacy Laws
State law may further limit the permissible ways the Plan uses or discloses your PHI. If an applicable state law imposes
stricter restrictions on the Plan, we will comply with that state law.
Effective Date: September 23, 2013