Page 134 - USUI Benefit Book

Effective July 1, 2019
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HIPAA Notice of Privacy Practices
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This Notice Describes How Medical Information About You May Be Used and Disclosed and How You Can Get
Access To This Information. Please Review It Carefully.

This notice describes the practices of the Usui Medical, 1. How The Plan May Use and Disclose Information
Dental and Vision Benefit Provisions of the Usui About You
International Group Health & Welfare Benefit Plan (the
"Plan") sponsored by Usui International Corporation The primary reasons for which the Plan may use and
(the "Company") with regard to the Protected Health disclose your PHI are to evaluate and process any
Information the Plan has about you that relates to your requests you may make for coverage and claims for
coverage under the Plan, and how the Plan may use and benefits. The following describes these and other uses
disclose this information. This notice also describes and disclosures, together with some examples.
your rights with respect to Protected Health Information
and how you can exercise those rights. A. For Payment. The Plan may use and disclose your
PHI to determine eligibility for Plan benefits, to facilitate
In this notice, "you" or "your" refers to anyone who is payment for the treatment and services you receive
covered by the Plan, including an employee, an from health care providers, to determine benefit
employee's spouse or a dependent child of the responsibility under the Plan, or to coordinate Plan
employee. coverage. For example, the Plan may tell your health
care provider about your medical history to determine
"Protected Health Information" ("PHI") includes whether a particular treatment is experimental,
individually identifiable information that relates to your investigational, or medically necessary or to determine
past, present or future health condition, treatment or whether the Plan will cover the treatment. The Plan
payment for health care services, and includes may also share PHI with a third party who assists in the
information such as your name, social security number, administration of the Plan. Likewise, the Plan may share
address and date of birth. PHI with another entity to assist with the adjudication or
subrogation of health claims or to another health plan
Our Pledge Regarding Protected Health Information. to coordinate benefit payments.
The Plan is obligated to safeguard your PHI from use or
disclosure that is not required or permitted by law. For B. For Health Care Operations. The Plan may use and
administration purposes, the Plan creates a record of disclose your PHI for other Plan operations. These uses
the health care claims paid or reimbursed under the and disclosures are necessary to administer the Plan.
Plan. This notice applies to all of the Plan’s records that For example, the Plan may use PHI in connection with
are PHI. In addition, the protections described in this conducting quality assessment and improvement
notice also apply to the records maintained by third activities; underwriting, premium rating, and other
parties who assist in the administration of the Plan, such activities relating to Plan coverage; arranging for
as the claims administrator. medical review, legal services, audit services, and fraud
and abuse detection programs; business planning and
The Plan is required by law to: development such as cost management; and business
management and general Plan administrative activities.
• make sure that PHI that identifies you is kept private; The Plan may also share PHI with a third party who
• give you this notice of the Plan's legal duties and assists in the administration of the Plan, such as claims
privacy practices with respect to PHI about you; administrators. PHI which is genetic information may
• notify you if there is a breach of your unsecured PHI; not be used for underwriting purposes.
and
• follow the terms of the notice that is currently in C. For Treatment. The Plan may use or disclose your
effect. PHI to facilitate medical treatment or services by
providers. The Plan may disclose your PHI to providers,