ERISA NOTICES
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.
HIPAA SPECIAL ENROLLMENT NOTICE
A federal law called HIPAA requires that we notify you of your right to enroll in the plan under its “special enrollment provision” if you acquire a new dependent, or if you decline coverage under this plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons. You should read this notice even if you plan to waive coverage at this time.
You have the right to: •
Get a copy of your health and claims records Correct your health and claims records
• • •
Request confidential communication
Ask the Plan to limit the information we share
• Get a list of those with whom the health plan has shared your information • Get a copy of this privacy notice • Choose someone to act for you • File a complaint if you believe your privacy rights have been violated You have some choices in the way the health plan uses & shares information as the Plan: • Answers coverage questions from your family, close • friends, or others involved in payment for your care • Provides disaster relief • Includes you in a hospital directory • Provides mental health care • Markets health plan services • Raises funds The health plan may use and disclose/share your information as it: • Helps manage the health care treatment you receive • Runs our organization • Pays for your health services • Administers your health plan • Helps with public health and safety issues • Does research • Complies with the law • Responds to organ and tissue donation requests and • work with a medical examiner or funeral director • Addresses workers’ compensation, law enforcement, and other government requests • Responds to lawsuits and legal actions Your Rights When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you. Get a copy of health and claims records - You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Loss of Other Coverage
If you are declining coverage for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after you or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). Marriage, Birth, or Adoption If you have a new dependent as a result of a marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. To request special enrollment or obtain more information, contact Angela Harrison | Human Resource Manager HMMG, LLC 6262 Veterans Parkway Columbus, GA 31908 706-494-3447
NOTICE OF PRIVACY PRACTICES
Plan Administrator HMMG, LLC 6262 Veterans Parkway Columbus, GA 31908 706-494-3447
Your Information. Your Rights. Our Responsibilities. HMMG, LLC is committed to maintaining and protecting the confidentiality of our employees’ personal information. This Notice of Privacy Practices applies to HMMG, LLC’s Group Health Plans (collectively, the Plans). The Plans are required by federal and state law to protect the privacy of your individually identifiable health information and other personal information. We are required to provide you with this Notice about our policies, safeguards and practices. When the Plans use or disclose your PHI, the Plans are bound by the terms of this Notice, or the revised Notice, if applicable.
Ask us to correct health and claims records •
You can ask us to correct health information about you that you think is incorrect or incomplete.
IMPORTANT NOTICE: This document contains general compliance information only and does not constitute legal advice. For advice specific to your situation, please consult your attorney or tax advisor.
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