Continued
YOUR RIGHTS
Get a copy of this privacy notice Choose someone to act for you
• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly. • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. • We will make sure the person has this authority and can act for you before we take any action. • You can complain if you feel we have violated your rights by contacting us using the information on page 9. • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling (877) 696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. • We will not retaliate against you for filing a complaint. For certain health information, you can tell us your choices about what to share. • If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. • Share information with your family, close friends, or others involved in payment for your care • Share information in a disaster relief situation If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
File a complaint if you feel your rights are violated
YOUR CHOICES
In these cases, you have both the right and choice to tell us to:
In these cases, we never share your information
• Marketing purposes • Sale of your information
unless you give us written permission:
How do we typically use or share your health information. • We typically use or share your health information in the following ways.
OUR USES AND DISCLOSURES
Help manage the health care treatment you receive
• We can use your health information and share it with professionals who are treating you. • We can use and disclose your information to run our organization and contact you when necessary. • We are not allowed to use genetic information to decide whether we will give you coverage and the price of that coverage. This does not apply to long term care plans. • We can use and disclose your health information as we pay for your health services. • We may disclose your health information to your health plan sponsor for plan administration.
Example: A doctor sends us information about your diagnosis and treatment plan so we can arrange additional services. Example: We use health information about you to develop better services for you.
Run our organization
45 Example: Your company contracts with us to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge. Example: We share information about you with your dental plan to coordinate payment for your dental work.
Pay for your health services
Administer your Plan
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