HIPAA Privacy Notice
NOTICE OF 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 IT CAREFULLY.
YOU MAY OBTAIN ADDITIONAL PAPER COPIES OF THIS NOTICE FROM THE PRIVACY OFFICER.
Effective Date of Notice:
The effective date of this notice is April 14, 2004. The Plan is required by law to take reasonable steps to ensure the privacy of your personally identifiable health information and to inform you about: (1) the Plan's uses and disclosures of Protected Health Information, (2) your privacy rights with respect to your Protected Health Information, (3) your right to file a complaint with the Plan and the Secretary of the U.S. Department of Health and Human Services, and (4) the person or office to contact for further information about the Plan's privacy practices. The term Protected Health Information includes all individually identifiable health information transmitted or maintained by the Plan, regardless of form (oral, written and electronic).
Notice of Protected Health Information (PHI) Uses and Disclosures:
Upon your request, the Plan is required to give you access to certain PHI so that you may inspect, amend, and copy it. Use and disclosure of your Protected Health Information may be required by the Secretary of the Department of Health and Human Services to investigate or determine the Plan's compliance with the privacy regulations. The Plan and its Business Associates will use or disclose Protected Health Information to the Plan Sponsor, CABLExpress Corporation, without your consent, authorization, or opportunity to agree or object in order to carry out payment, treatment, or health care operations. The Plan Sponsor has amended the Plan document(s) to protect your Protected Health Information as required by federal law.
Treatment is the provision, coordination or management of health care and related services. It includes, but is not limited to, consultations and referrals between one or more of your providers.
Payment includes, but is not limited to, actions to determine coverage and payment (including billing, claim management, subrogation, review for medical necessity, and utilization review.)
Health care operations includes, but is not limited to, quality assessment and improvement, reviewing competence or qualifications of health care professionals, underwriting, and other activities related to creating and renewing insurance contracts. It also includes disease management programs, medical reviews, auditing, business planning and development, and general administrative activities.
Your written authorization will generally be obtained prior to use or disclosure of psychotherapy notes from your psychotherapist. These are separately filed notes about your conversations with your health care professional during your counseling sessions. They do not include summary information about your mental health treatment.
Use and disclosure is also permitted without your consent or authorization (1) when required by law, (2) when permitted for the purpose of health activities, such as exposure to communicable disease or risk of spreading such disease, (3) when authorized by law to report information about abuse, neglect, or domestic violence, or to public authorities when a reasonable belief exists that you may be the victim of such violence or abuse, (4) to public oversight agencies for activities authorized by law such as to investigate Medicare or Medicaid fraud, (5) when required for judicial or administrative proceedings such as in response to a subpoena (prior to release, the Plan must make a good faith attempt to provide written notice to you), (6) when required for law enforcement purposes, (7) when required to be given to a coroner or medical examiner for the purpose of identifying a deceased person, determining the cause of death, etc., (8) for research, subject to conditions, (9) when the use or disclosure will lessen a serious and imminent threat to health and safety of a person or to the public, (10) when required by the Food and Drug Administration to report adverse events, product defects, to enable product recalls, repairs or replacements, or to conduct post marketing surveillance, (11) when required by an organ, eye or tissue donation entity, (12) to specialized government functions, when the appropriate conditions apply, (13) when required by a correctional institution or a law enforcement official if you are an inmate of that correctional facility and your PHI is necessary to provide care and treatment to you or is necessary for the health and safety of other individuals or inmates, (14) when required in association with a Workers' Compensation claim, (15) when required by a public or private entity authorized to assist in disaster relief efforts.
Rights of Individuals:
You may request the Plan restrict its use of Protected Health Information to that allowed by law. However, the Plan is not obligated to agree to your request. The Plan will accommodate reasonable requests to receive communications of Protected Health Information by alternative means or at alternative locations. You or your personal representative will be required to complete a form to request restrictions on the use of Protected Health Information. Such requests should be addressed to the Privacy Officer.
You have a right to request a copy of Protected Health Information held in the Designated Record Set for as long as the Plan maintains Protected Health Information. A designated record set includes, but is not limited to, the medical and billing records about individuals maintained by or for a covered health care provider, enrollment, billing, claim adjudication and case or medical management record systems. Protected Health Information includes all individually identifiable health information transmitted or maintained by the Plan, regardless of the form. We will provide the requested information within 30 days if the information is maintained on site or within 60 days if the information is maintained off site. A single 30-day extension is permitted if the Plan is unable to comply with the deadline.
We will require that you or your personal representative complete a form to request access to Protected Health Information. Requests should be made to the Privacy Officer. If we deny access, we will provide you with a written denial setting forth the basis for the denial and a description of how you may exercise your review rights and a description of how you may file a complaint with the Secretary of the U.S. Department of Health and Human Services.
You have the right to request that the Plan amend your Protected Health Information or a designated record set for as long as the Protected Health Information is maintained in the designated record set. Your request to amend your Protected Health Information should be addressed to the Privacy Officer. We will require you or your personal representative to complete a form to amend your Protected Health Information. The Plan has 60 days from the date of your request to act on your request. A single 30-day extension is allowed if the Plan is unable to comply with the deadline. If the request is denied in whole or in part, the Plan must provide you with a written denial that explains the basis for the denial. You or your personal representative may submit a written statement disagreeing with the denial and have that statement included with future disclosures of Protected Health Information.
You have the right to obtain an accounting of disclosures of your Protected Health Information during the six years prior to the date of your request. The Plan does not have to provide you with an accounting of disclosures prior to April 14, 2004, or for disclosures made for treatment, payment or health care operations, or those made based on your written authorization. We must provide you an accounting within 60 days of your request. If we cannot provide the information within 60 days, we may take an additional 30 days if we provide you a written statement explaining why the extension is required and the date the accounting will be provided. If you request more than one accounting in a 12-month period, the Plan will charge a reasonable fee for each subsequent accounting.
You may exercise your rights through a personal representative. The Plan will require your personal representative to produce evidence of his/her authority to act on your behalf before that individual will have access to your Protected Health Information or be allowed to take any action for you. Examples of a personal representative are (1) notarized power of attorney for health care purposes, (2) a court order of appointment of the person as a conservator or guardian of the individual, or (3) a parent of a minor child. The Plan retains discretion to deny to your personal representative access to your Protected Health Information if the Plan feels that those individuals who rely on others to exercise their rights under these rules may be subject to abuse or neglect. This also applies to personal representatives of minors.
Plan Duties:
The Plan is required to maintain the privacy of Protected Health Information and to provide participants and beneficiaries with notice of its legal duties and privacy practices. The Plan reserves its right to change privacy practices and to apply any changes to Protected Health Information received or maintained prior to that date. If a privacy practice is materially amended, a revised version of this notice will be provided to all participants and beneficiaries for whom the Plan maintains Protected Health Information. The revised version will be distributed via either first class mail, interoffice mail or e-mail. A revised version will be distributed within 60 days of the effective date of any material change to the uses and disclosures, the individual's rights, the duties of the Plan, or any other privacy practices stated in this notice.
When using or disclosing or when requesting Protected Health Information, the Plan will make reasonable efforts not to use more than the minimum amount necessary to accomplish the intended purpose. The minimum necessary standard will not apply to (1) disclosures to or requests by a health care provider for treatment, (2) use or disclosure to the individual, (3) disclosure made to the Secretary of the U.S. Department of Health and Human Services, (4) use or disclosure required by law, (5) use or disclosure required for the Plan's compliance with legal regulations.
This notice does not apply to de-identified information. De-identified information is information that does not identify the individual and for which there is no reason to believe that the information could identify the individual.
The Plan may provide summary health information to the Plan Sponsor to obtain premium bids, modify, amend, or terminate the health Plan.
Your Right to File a Complaint with the Plan or HHS Secretary:
If you believe your privacy rights have been violated, you may file a written complaint with the Plan in care of the Privacy Officer. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services, Hubert Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. The Plan will not retaliate against you for filing a complaint.
Whom to Contact at the Plan for More Information:
If you have questions about this notice or the subjects addressed in it, please contact the Privacy Officer.
Conclusion:
PHI use and disclosure by the Plan is regulated by federal law known as HIPAA (Health Insurance Portability and Accountability Act of 1996). You may find these rules at 45 Code of Federal Regulations Parts 160 and 164. This notice attempts to summarize the regulations. The regulations will supersede any discrepancy between the information in this notice and the regulations.
Privacy Officer: Tawney Crystal
Title: Human Resources Manager
Address: 5404 South Bay Road, P.O. Box 4799
Address: Syracuse, New York 13221
Phone: (315) 476-3000
Email address: hipaa@cxtec.com
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HIPAA Privacy Officer
Privacy Officer: Tawney Crystal
Title: Human Resources Manager
Address: 5404 South Bay Road, P.O. Box 4799
Address: Syracuse, New York 13221
Phone: (315) 476-3000
Email address: tcrystal@cxtec.com
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