Privacy StatementAt American Benefits Group, your privacy is very important to us. All of the information we receive from you will be held in the strictest confidence, and will not be used for any purpose other than that for which it was intended. No information about you will be sold, reused, rented, loaned, or otherwise disclosed except as may be provided herein.
If you have any questions about your privacy, please contact us.
OUR PLEDGE REGARDING MEDICAL INFORMATIONWe understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the health care claims reimbursed under the Plan for Plan administration purposes. This notice applies to all of the medical records we maintain. Your personal doctor or health care provider may have different policies or notices regarding the doctor’s use and disclosure of your medical information created in the doctor’s office or clinic.
We are required by law to:
- make sure that medical information that identifies you is kept private
- give you this notice of our legal duties and privacy practices with respect to medical information about you
- follow the terms of our policy as it is currently in effect.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOUThe following categories describe different ways that we use and disclose medical information for purposes of health plan administration. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a Page 1of 4 Effective 1/1/05
category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
For Payment (as described in applicable regulations). We may use medical information about you to determine eligibility for Plan benefits, to determine benefit responsibility under the Plan, or to coordinate Plan coverage. For example, we may share medical information with another entity to assist with the adjudication or subrogation of health claims or to another health plan to coordinate benefit payments.
As Required By Law. We will disclose medical information about you when required to do so by federal, state or local law.
To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
SPECIAL SITUATIONSPublic Health Risks. We may disclose medical information about you for public health activities (e.g., to prevent or control disease, injury or disability).
Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Law Enforcement. We may release medical information if asked to do so by a law enforcement official in response to a court order, subpoena, warrant, summons or similar process.
Coroners and Medical Examiners. We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death.
National Security and Intelligence Activities. We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOUYou have the following rights regarding medical information we maintain about you:
Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your Plan benefits. To inspect and copy medical information that may be used to make decisions about you, you must submit your request to us in writing. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
We may deny your request to inspect and copy in certain very limited circumstances. HIPAA provides several important exceptions to your right to access your PHI. For example, you will not be permitted to access information compiled in anticipation of, or for use in, a civil, criminal or administrative action or proceeding. If you are denied access to medical information, you may request that the denial be reviewed.
Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the Plan.
To request an amendment, your request must be made in writing and must provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
- Is not part of the medical information kept by or for the Plan
- Is not part of the information which you would be permitted to inspect and copy
- Is accurate and complete
Right to an Accounting of Disclosures. You have the right to request an "accounting of disclosures" (other than disclosures you authorized in writing) where such disclosure was made for any purpose other than payment.
To request this list or accounting of disclosures, you must submit your request in writing. Your request must state a time period which may not be longer than six years and may not include dates before April 2003. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Note that HIPAA provides several important exceptions to your right to an accounting of the disclosures of your PHI. We will not include in your accounting any of the disclosures for which there is an exception under HIPAA. We must act on your request for an accounting of the disclosures of your PHI no later than 60 days after receipt of the request. We may extend the time for providing you an accounting by no more than 30 days, but it must provide you a written explanation for the delay. You may request one accounting in any 12-month period free of charge. We will impose a fee for each subsequent request within the 12-month period.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
To obtain a paper copy of this notice call us at 800-499-3539 (800-499-FLEX).
We must make our internal practices, books and records related to the use and disclosure of PHI received from the Plan available to the Secretary of Health and Human Services for purposes of determining compliance of the Plan with these privacy protections.
When we no longer need PHI disclosed to us, for the purposes for which the PHI was disclosed, we must, if feasible, return or destroy the PHI that is no longer needed.