|ProMed Health Care
Notice of HIPAA Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW
Why is the Plan providing me with this Privacy Notice?
is being provided to you in accordance with the requirements of the Standards
for Privacy of Individually Identifiable Health Information of the Health
Insurance Portability and Accountability Act (the "HIPAA Privacy
Rules") The HIPAA Privacy Rules are federal laws that seek to ensure
the privacy and confidentiality of your health information. The HIPAA
Privacy Rules require the Plan to take certain actions to protect the
privacy of your health information. This Notice has been prepared to advise
you of the uses and disclosures of your Protected Health Information (as
defined below that my be made by the Plan and to advise you or your rights
and the Plan's legal duties relating to the privacy of your Protected
What is Protected
Health Information (PHI) means information related to a past or present
health condition that individually identifies you or could reasonably
be used to identify you and is transferred to another entity or maintained
by the Plan in written, electronic or any other form.
Will the Plan have
access to my Protected Health Information?
a Plan enrollee, you should be aware that the Plan may have access to
your Protected Health Information from time to time. The Plan may receive
your Protected Health Information in a variety of ways. For example, the
Plan may receive this kind of information when your health care provider
(doctor, hospital, etc.) submits bills for services rendered to you in
order that benefits can be paid by the Plan.
When may the Plan
use or disclose my Protected Health Information?
permits the Plan to use or disclose Protected Health Information to carry
out "treatment," "payment" and other "health
care operations". When the Plan uses or disclosures your Protected
Health Information for treatment, payment or health care operations purposes,
the Plan is not required to notify you or obtain your authorization (discussed
means the provision, coordination, or management of health care and related
services by health care providers, including the coordination or management
of health care by a health care provider with a third party (such as an
insurer of the Plan), consultation between producers with respect to a
patient, and the referral of a patient for heath care from one provider
to another. The Plan itself does not engage directly in "treatment"
under the HIPAA privacy Rules. However, the Plan may interact with a health
care provider in treatment transactions.
means activities undertaken by the Plan to determine or fulfill its responsibility
for coverage and provision of benefits under the Plan. Examples of when
the Plan might use or disclose Protected Health Information for payment
purposes include disclosures to facilitate the payment of claims made
against the Plan by health care providers, the Plan's activities to obtain
or provide reimbursement for the provision of health care of the Plan's
activities in obtaining premiums. When the Plan discloses information
for payment purposes, the Plan will attempt only to disclose that Protected
Health Information which is minimally necessary to ensure proper and timely
payment of claims.
Health Care Operations:
"Health care operations" means those other functions and activities
that the Plan performs in connection with providing health care benefits.
Example of what constitute health care operations during which the Plan
might use or disclose your Protected Health Information include activities
relating to creation, renewal or replacement of a contract of health insurance
or health benefits, business planning and development relating to the
Plan, and compliance with the HIPAA Privacy Rules. Another example would
include the Plan's use or disclosure of Protected Health Information to
better manage its operations, such as when the Plan discloses information
with a vendor or consultant (commonly referred to as a "Business
Associate" to ensure proper accounting and record-keeping relating
to the Plan's provisions of health care benefits.
May the Plan use
or disclose my Protected Health Information for other purposes?
uses or disclosures of Protected Health Information that are not made
for treatment, payment, or health care operations and for which no exception
regarding Authorization applies, the law requires the Plan to obtain your
Authorization. An Authorization is your approval for the Plan's disclosure
of your Protected Health Information to a particular person or entity
for a particular purpose. You may revoke an Authorization at any time,
but a revocation is not effective if the Plan has already reasonably relied
on your Authorization to make a particular use or disclosure. Examples
of when an Authorization would be required include when the uses or disclosures
are made to your employer for disability, fitness for duty or drug testing
purposes. Additionally, if you request that the Plan make use of or disclose
your Protected Health Information to a third party, the Plan may require
that you sign an Authorization that permits the Plan to honor your request.
When might the
Plan make use of or disclose my Protected Health Information without my
above, the Plan is not required to obtain your Authorization for uses
or disclosure of your Protected Health Information for treatment, payment
or health care operations purposes. Additionally, there are some limited
exceptions where the law allows the Plan to make use or disclosure of
your Protected Health Information without your Authorization. Most of
these uses or disclosure are permitted to promote the government's need
to ensure a sage and healthy society. In some cases, you may be given
an opportunity to agree or object before the use or disclosure is made;
in other cases, you may not be given this opportunity. Whenever the Plan
makes these types of uses and disclosures, the Plan ensures that it meets
any necessary prerequisites and will not use or disclose your Protected
Health Information more than is otherwise permitted under the law.
The types of uses
or disclosures of Protected Health Information that may be made without
your Authorization and without giving you the opportunity to object include
- To avert communicable
or spreading diseases;
- For public health
- For federal intelligence,
counter-intelligence and national security purposes;
- To properly assist
law enforcement to carry out their duties;
- When a judge or
administrative tribunal orders the release of such Protected Health
- For cadaver organ,
eye and tissue donations (where appropriate);
- To help apprehend
- To assist armed
forces personnel and operations;
- For military service,
veteran's affairs separation/discharge matter;
- For coroner/medical
- For health oversight
purposes (such as when the government requests certain information from
the Plan to determine its compliance with applicable laws);
- To assist victims
of abuse, neglect or domestic violence;
- To address work-related
illness/workplace injuries and for worker's compensation purposes;
- To carry out clinical
research that involves treatment where the proper body has determined
the importance of doing so;
- For FDA-related
- For certain health
and safety purposes;
- For funeral/funeral
- To help determine
veterans' eligibility status;
- To protect Presidential
and other high-ranking officials; and
- For reporting to
correctional institutions/law enforcement officials acting in a custodian
There are also sever
types of uses or disclosures of Protected Health Information that the
Plan may make without your Authorization as long as, whenever possible,
you are given an opportunity to agree or object before the Plan makes
the use of disclosure. These exceptions are very limited and generally
involve the release of a limited amount of Protected Health Information
to aid your family members, close personal friends, or disaster relief
personnel in locating you in the even of an emergency or in case of your
Will the Plan disclose
my Protected Health Information to my employer?
has the right to disclose your Protected Health information to the Plan
Sponsor, which is usually your employer, subject to certain limitations.
The Plan may generally disclose to the Plan Sponsor information regarding
whether you are enrolled in the Plan and "summary health information,"
which means information that summarizes the claims history and experiences
of the individuals enrolled in the Plan without specifically identifying
you or other Plan participants. The Plan may disclose this information
without your Authorization, and the Plan Sponsor may only use the information
for its activities relating to its sponsorship of the Plan. For example,
the Plan Sponsor may use this information to seek bids from health insurers
or to analyze its health plan expenses. If the Plan Sponsor needs more
than "summary health information" or enrollment information
to carry out its responsibilities, then documents that govern the Plan
will determine the extent to which Protected Health Information may be
used or disclosed, except that in no case may the Plan Sponsor use or
disclose your Protected Health Information for employment-related decisions
for any other purpose other than as permitted by the Plan documents or
by law. Additionally, a Plan Sponsor that receives Protected Health Information
from a Plan must make certain certifications to the Plan regarding the
uses and disclosures of the information and must ensure that any agents
or subcontractors of the Plan Sponsor agree to the same restrictions and
conditions that apply to the Plan Sponsor.
Will the Plan use
or disclose my Protected Health Information for marketing, fundraising
or other similar purposes?
Plan does not anticipate using or disclosing your Protected Health Information
for marketing, fundraising or other similar purposes, under the HIPAA
Privacy Rules, the Plan only make such uses or disclosures with your Authorization,
unless the Plan communicates with you face-to-face or provides you with
some promotional gift of nominal value, in which case your Authorization
would not be required.
Do I have the right
to request additional restrictions on the uses or disclosures of my Protected
have the right to request additional restrictions relating to the Plan's
use or disclosure of your Protected Health Information beyond those otherwise
required under the HIPAA Privacy Rules. Although the Plan is not legally
required to grant these requests, it is your right to make such a request.
For additional information or to obtain the proper form for making such
a request, please contact the Plan's Privacy Officer.
May I request that
certain communications of my Protected Health Information can be made
to me at alternate locations?
Plan may communicate your Protected Health Information to you in a variety
of ways, including by mail or telephone. If you believe that the Plan's
communications to you by the usual means will endanger you or your health
care and you would like the Plan to make its communications that involve
Protected Health Information to you at an alternate location, you may
contact the Plan's Privacy Officer to obtain the appropriate request form.
The Plan will only accommodate reasonable requests and may require information
as to how payment, if any, will be handled.
Do I have the right
to obtain access to my Protected Health Information?
You have the right to request and obtain access to your Protected Health
Information maintained by the Plan unless an exception applies. The Plan
may deny you access to your Protected Health Information if the information
is not required to be accessible under the HIPAA Privacy Rules or other
applicable law. For example, you do not have a right to access information
compiled by the Plan in anticipation of or for use in a civil, criminal
or administrative proceeding.
The Plan may charge
you a reasonable, cost-based fee for copying (including the cost of supplies
and labor) any Protected Health Information required to be copied to adequately
respond to your access request, as well as any postage costs and costs
associated with preparing an explanation or summary of the Protected Health
Information necessary to adequately respond to your access request (unless
otherwise precluded by applicable State or other law). If you would like
to request access to you Protected Health Information, please notify the
Plan's Privacy Officer so that you can complete the appropriate forms.
Do I have the right
to an accounting of disclosures of my Protected Health Information made
by the Plan?
have the right to request and obtain a proper accounting of disclosures
the Plan has made of your Protected Health Information that the Plan makes.
For example, the Plan is not required to provide an accounting for disclosures
made for treatment, payment, or health care operations purposes or for
disclosures made with your Authorization. Additionally, the Plan reserves
the right to limit its accounts to disclosures made after the compliance
date of the HIPAA Privacy Rules.
The Plan will provide
you with your first accounting at no charge to you. If you request any
additional accountings within a 12-month period, the Plan may charge you
a reasonable cost-based fee. At the time that you request a subsequent
accounting, the Plan will provide you with information regarding the fees
and you will have the opportunity to withdraw or modify your request if
you wish to do so.
If I have an objection
to the way my Protected Health Information is being handled, may I file
Yes. The Plan has procedures in place for receiving and resolving
complaints. If you believe that the Plan has violated your privacy right
or has acted inconsistently with its obligations under the HIPAA Privacy
Rules, you may file a complaint by contacting the Plan's Privacy Officer.
You may send a letter outlining your complaint to the Privacy Officer
or you may call the Privacy Officer and request a complaint form. The
Plan requests that you attempt to resolve your complaint with the Plan
via theses complaint procedures since the Plan is in the best position
to respond to your complaint. However, if you believe the Plan has violated
your privacy rights, you may also file a complaint with the Office of
Civil Rights ("OCR") at the United States Department of Health
and Human Services ("HHS"). You may contact the HHS OCR at:
Medical Privacy, Complaint Division, Office of Civil Rights, United States
Department of Health and Human Services, 200 Independence Avenue, S.W.,
Room 509F, HHH Building, Washington, D.C. 20201. Voice Hotline Number
(800) 368-1019. Internet Address www.hhs.gov/ocr.
It is against the
policies and procedures of the Plan to retaliate against any person who
has filed a privacy complaint, either with the Plan or with HHS OCR. Should
you believe that you are retaliated against in any way upon your filing
a complaint with the Plan or the HHS OCR, please immediately contact the
Plan's Privacy Officer, so that the Plan may properly address the issue.
May I obtain a copy of this Notice?
you received this Notice via the Internet or electronic mail, you have
the right to request and receive a paper copy of this Notice. If you would
like to receive a paper copy of this Notice, please contact the Plan's
What if I have
additional questions that are not answered in this Notice?
If you have
any questions, concerns or issues relating to the privacy of your Protected
Health Information that is not covered in this Notice, please contact
the Plan's Privacy Officer.
How do I contact
the Plan's Privacy Officer?
contact the Plan's Privacy Officer by writing to Laura Alcala, Member
Services Manager, 4150
East Concours Street, Suite 100
Ontario, CA 91764-4989 Effective
April 14, 2003.