Page 37 - NYMets_2018_Benefits_Guide

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Privacy Rights Under HIPAA
A federal law, the Health Insurance Portability and Summary of Benefit and
Accountability Act of 1996 (HIPAA), requires that health plans Coverage (SBC) Document(s)
protect the confidentiality of your private health information.
As required by law, across the US, insurance companies
This Plan, the Plan Administrator and the Plan Sponsor will and group health plans like ours are providing plan
not use or disclose information that is protected by HIPAA participants with a consumer-friendly SBC as a way to
(protected health information) except as necessary for help understand and compare medical benefits. Each
treatment, payment, and other health care operations of the SBC contains concise medical plan information, in plain
Plan, or as permitted or required by law. In particular, the Plan language, about benefits and coverage, including, what is
will not, without authorization, use or disclose protected health covered, what you need to pay for various benefits, what
information for employment-related actions and decisions, or is not covered and where to go for more information or to
in connection with any other benefit or employee benefit plan get answers to questions. SBC documents are updated
of your Employer. when there is a change to the benefits information
displayed on an SBC.
The Plan also requires all of its business associates (as
that term is defined by HIPAA) to observe HIPAA’s privacy Government regulations are very specific about the
information that can and cannot be included in each SBC.
requirements.
Plans are not allowed to customize very much of the SBC
Protected health information may be used by and disclosed documents. There are detailed instructions the Plan had
to Human Resources, and Benefits and Finance/Accounting to follow about how the SBCs look, how many pages the
employees of your Employer who are responsible for carrying SBC should be (maximum 4-pages), the font size, the
out administrative functions for the Plan (such as enrollment/ colors used when printing the SBC and even which words
disenrollment, determinations of eligibility and benefits due, were to be bold.
payments to providers, reimbursements to participants and To get a copy of the most current Summary of Benefits
audits). and Coverage (SBC) documents for our medical plans,
contact Human Resources.
However, these employees will only have access to the
information on a “need to know” basis and will use only
the minimum necessary protected health information to
accomplish the intended Plan administration purpose.

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