Page 136 - USUI Benefit Book
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A. Right to Inspect and Copy. You have the right to
inspect and copy your PHI that is maintained in a C. Right to an Accounting of Disclosures. You have the
"Designated Record Set". A Designated Record Set right to request an "accounting of disclosures" the Plan
includes enrollment, payment, billing, claims has made of your PHI. This accounting or list will not
adjudication, and medical management record systems include disclosures made for treatment, payment, or
maintained by or for the Plan that is used to make health care operations; made to law enforcement
decisions about individuals. personnel; made pursuant to your authorization; or
made directly to you.
To inspect and copy PHI in a Designated Record Set, you
must submit your request in writing to the Privacy To request this list or accounting of disclosures, you
Officer designated below. If you request a copy of the must submit your request in writing to the Privacy
information, the Plan may charge a fee for the costs of Officer. Your request must state a time period which
copying, mailing or other supplies associated with your may not be longer than six years. Your request should
request. indicate in what form you want the list (for example,
paper or electronic). The first list you request within a
If you request an electronic copy of your PHI that the 12-month period will be free. For additional lists, the
Plan maintains electronically, the Plan may be required Plan may charge you for the costs of providing the list.
to provide you with access to the electronic information The Plan will notify you of the cost involved and you
in the electronic form and format that you requested, if may choose to withdraw or modify your request at that
it is readily producible, or, if not, in a readable electronic time before any costs are incurred.
form and format as agreed to. To the extent possible
and requested, the Plan will provide you with an D. Right to Request Restrictions. You have the right to
electronic copy of your PHI. request a restriction or limitation on the PHI the Plan
uses or discloses about you for treatment, payment or
The Plan may deny your request to inspect and copy in health care operations. You also have the right to
very limited circumstances. If you are denied access to request a limit on the PHI the Plan discloses about you
PHI, you may request that the denial be reviewed. to someone who is involved in your care or the payment
for your care, like a family member or friend. For
B. Right to Amend. If you feel that PHI the Plan has example, you could ask that the Plan not use or disclose
about you is incorrect or incomplete, you may ask the information about a surgery you had.
Plan to amend the information. You have the right to
request an amendment for as long as the information is The Plan is not required to agree to your request.
kept by or for the Plan.
To request restrictions, you must make your request in
To request an amendment, your request must be made writing to the Privacy Officer. In your request, you must
in writing and submitted to the Privacy Officer. In tell the Plan (1) what information you want to limit; (2)
addition, you must provide a reason that supports your whether you want to limit the Plan's use, disclosure or
request. both; and (3) to whom you want the limits to apply, for
example, disclosures to your spouse. If the Plan agrees
The Plan may deny your request for an amendment if it to a restriction, it may terminate its agreement to such
is not in writing or does not include a reason to support restriction upon notice to you. Such termination is only
the request. In addition, the Plan may deny your effective for PHI created or received by the Plan after
request if you ask the Plan to amend information that: the termination.
• is not part of the PHI kept by or for the Plan; E. Right to Request Confidential Communications.
• was not created by the Plan, unless the person or You have the right to request that the Plan
entity that created the information is no longer communicate with you about your PHI in a certain way
available to make the amendment; or at a certain location, if you tell the Plan that
• is not part of the information that you would be communication in another manner may endanger you.
permitted to inspect and copy; or For example, you can ask that the Plan only contact you
• is accurate and complete. at work or by mail.
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