Page 32 - Confie Benefits Guide 01-18_FINAL_r2_dp wording.pub

Important No ces (con nued)

result in harm to you; or 3) it is not in your best interest to treat such The Plan May Contact You
person as your personal representa ve.
The Plan may contact you for various reasons, usually in connec on with
Public Health: To the extent that other applicable law does not prohibit claims and payments and usually by mail.
such disclosures, the Plan may disclose your PHI for purposes of certain You should note that the Plan may contact you about treatment alterna‐
public health ac vi es, including, for example, repor ng informa on ves or other health‐related benefits and services that may be of interest
related to an FDA‐regulated product’s quality, safety or effec veness to a to you.
person subject to FDA jurisdic on.
Your Rights With Respect to Your PHI
Health Oversight Ac vi es: The Plan may disclose your PHI to a public
health oversight agency for authorized ac vi es, including audits, civil, Confiden al Communica on by Alterna ve Means: If you feel that disclo‐
administra ve or criminal inves ga ons; inspec ons; licensure or discipli‐ sure of your PHI could endanger you, the Plan will accommodate a rea‐
nary ac ons. sonable request to communicate with you by alterna ve means or at
alterna ve loca ons. For example, you might request the Plan to com‐
Coroner, Medical Examiner, or Funeral Director: The Plan may disclose municate with you only at a par cular address. If you wish to request
your PHI to a coroner or medical examiner for the purposes of iden fying confiden al communica ons, you must make your request in wri ng to
a deceased person, determining a cause of death or other du es as au‐ the contact person named at the end of this No ce. You do not need to
thorized by law. Also, the Plan may disclose your PHI to a funeral director, state the specific reason that you feel disclosure of your PHI might endan‐
consistent with applicable law, as necessary to carry out the funeral direc‐ ger you in making the request, but you do need to state whether that is
tor’s du es.
the case. Your request also must specify how or where you wish to be
Organ Dona on: The Plan may use or disclose your PHI to assist en es contacted. The Plan will no fy you if it agrees to your request for confi‐
engaged in the procurement, banking, or transplanta on of cadaver or‐ den al communica on. You should not assume that the Plan has accept‐
gans, eyes, or ssue. ed your request un l the Plan confirms its agreement to that request in
wri ng.
Specified Government Func ons: In specified circumstances, federal
regula ons may require the Plan to use or disclose your PHI to facilitate Request Restric on on Certain Uses and Disclosures: You may request
specified government func ons related to the military and veterans, na‐ the Plan to restrict the uses and disclosures it makes of your PHI. This
onal security and intelligence ac vi es, protec ve services for the presi‐ request will restrict or limit the PHI that is disclosed for Treatment, Pay‐
dent and others, and correc onal ins tu ons and inmates. ment, or Health Care Opera ons, and this restric on may limit the infor‐
ma on that the Plan discloses to someone who is involved in your care or
Research: The Plan may disclose your PHI to researchers when your indi‐
vidual iden fiers have been removed or when an ins tu onal review the payment for your care. The Plan is not required to agree to a request‐
board or privacy board has reviewed the research proposal and estab‐ ed restric on, but if it does agree to your requested restric on, the Plan
lished a process to ensure the privacy of the requested informa on and is bound by that agreement, unless the informa on is needed in an emer‐
approves the research. gency situa on. There are some restric ons, however, that are not per‐
mi ed even with the Plan’s agreement. To request a restric on, please
Disclosures to You: When you make a request for your PHI, the Plan is submit your wri en request to the contact person iden fied at the end of
required to disclose to you your medical records, billing records, and any this No ce. In the request please specify: (1) what informa on you want
other records used to make decisions regarding your health care benefits. to restrict; (2) whether you want to limit the Plan’s use of that infor‐
The Plan must also, when requested by you, provide you with an ac‐ ma on, its disclosure of that informa on, or both; and (3) to whom you
coun ng of disclosures of your PHI if such disclosures were for any reason want the limits to apply (a par cular physician, for example). The Plan will
other than Treatment, Payment, or Health Care Opera ons (and if you did no fy you if it agrees to a requested restric on on how your PHI is used
not authorize the disclosure). or disclosed. You should not assume that the Plan has accepted a request‐
ed restric on un l the Plan confirms its agreement to that restric on in
Authoriza on to Use or Disclose Your PHI
wri ng. You may request restric ons on our use and disclosure of your
Except as stated above, the Plan will not use or disclose your PHI unless it confiden al informa on for the treatment, payment and health care op‐
first receives wri en authoriza on from you. If you authorize the Plan to era ons purposes explained in this No ce. Notwithstanding this policy,
use or disclose your PHI, you may revoke that authoriza on in wri ng at the plan will comply with any restric on request if (1) except as otherwise
any me, by sending no ce of your revoca on to the contact person required by law, the disclosure is to the health plan for purposes of carry‐
named at the end of this No ce. To the extent that the Plan has taken ing out payment or health care opera ons (and it is not for purposes of
ac on in reliance on your authoriza on (entered into an agreement to carrying out treatment); and (2) the PHI pertains solely to a health care
provide your PHI to a third party, for example) you cannot revoke your item or service for which the health care provider has been paid out‐of‐
authoriza on. pocket in full.
Furthermore, we will not: (1) supply confiden al informa on to another Right to Be No fied of a Breach: You have the right to be no fied in the
company for its marke ng purposes (unless it is for certain limited Health event that the plan (or a Business Associate) discovers a breach of unse‐
Care Opera ons); (2) sell your confiden al informa on (unless under cured protected health informa on.
strict legal restric ons) (to sell means to receive direct or indirect remu‐
Electronic Health Records: You may also request and receive an ac‐
nera on); (3) provide your confiden al informa on to a poten al em‐
coun ng of disclosures of electronic health records made for treatment,
ployer with whom you are seeking employment without your signed au‐
payment, or health care opera ons during the prior three years for disclo‐
thoriza on; or (4) use or disclose psychotherapy notes unless required by
sures made on or a er (1) January 1, 2014 for electronic health records
law. Addi onally, if a state or other law requires disclosure of immuniza‐
acquired before January 1, 2009; or (2) January 1, 2011 for electronic
on records to a school, wri en authoriza on is no longer required. How‐
health records acquired on or a er January 1, 2009. The first list you re‐
ever, a covered en ty s ll must obtain and document an agreement
quest within a 12‐month period will be free. You may be charged for
which may be oral and over the phone.
providing any addi onal lists within a 12‐month period.

32