ERISA NOTICES
In these cases, you have both the right and choice to tell us to: 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. In these cases, we never share your information unless you give us written permission: • Marketing purposes • Sale of your information Our Uses and Disclosures How do we typically use or share your health information? We typically use or share your health information in the following ways. • Help manage the health care treatment you receive - We can use your health information and share it with other professionals who are treating you.
• Ask us how to do this. We may say “no” to your request, but
we’ll tell you why in writing within 60 days.
Request confidential communications • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. • We will say “yes” to all reasonable requests. Ask us to limit what we use or share • You can ask us not to use or share certain health information for treatment, payment, or our operations. • We are not required to agree to your request, and we may say “no” if it would affect your care. Get a list of those with whom we’ve shared information • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Example : A doctor treating you for an injury asks another doctor about your overall health condition.
Get a copy of this privacy notice •
• Runs the organization - We can use and share your health information to run our practice, improve your care, and contact you when necessary.
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.
Example : We use health information about you to manage your treatment and services.
Choose someone to act for you •
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. File a complaint if you feel your rights are violated • You can complain if you feel we have violated your rights by contacting the Plan. • 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 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. • We will not retaliate against you for filing a complaint Your Choices For certain health information, you can tell us your choices about what we 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.
• Pay for your healthcare services - We can use and share your health information to bill and get payment from health plans or other entities.
Example : We give information about you to your health insurance plan so it will pay for your services.
• Administer your plan - We may disclose your health information to your health plan sponsor for plan administration. 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. How else can we use or share your health information? We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information, see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.ht ml.
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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