THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
We respect the privacy of your protected health information and are committed to maintaining our employees’ confidentiality. This Notice applies to all information and records that our Group Health and Section 125/129 Plans (“Plan”) have received or created. It extends to information received or created by our employees, staff, and others involved with the implementation and administration of the Plan. During the course of providing you with health care coverage, the Plan will have access to information about you that is deemed “protected health information,” or PHI under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). Albright Care Services collects PHI in order to provide benefits under the Plan.
This Notice informs you about the possible uses and disclosures of your PHI. It also describes your rights and our obligations regarding your PHI. We are required by law to:
- maintain the privacy of your PHI;
- provide to you this detailed Notice of our legal duties and privacy practices relating to your PHI; and
- abide by the terms of the Notice that are currently in effect.
Your PHI will be disclosed to certain employees of Albright Care Services, including managers and administrators of Human Resources, Benefits, Payroll and Accounting, for the purposes of benefits administration. These individuals may only use your PHI for Plan administration functions, including those described in this Notice. Any Albright Care Services’ employee who violates the rules for handling PHI will be subject to the company’s established disciplinary process.
Albright Care Services has certified that it will comply with the privacy procedures set forth herein. Albright Care Services may not use or disclose your PHI other than as provided herein or as required by law. Any agents or subcontractors who are provided your PHI must agree to be bound by the restrictions and conditions concerning your PHI found here. Your PHI may not be used by Albright Care Services for any employment-related actions or decisions, or in connection with any other benefit or employee benefit plan of Albright Care Services.
- WE MAY USE AND DISCLOSE YOUR PERSONAL HEALTH INFORMATION FOR TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS WITHOUT NEEDING TO OBTAIN YOUR CONSENTWe may use and disclose your PHI for purposes of treatment, payment and health care operations. We have described these uses and disclosures below and provide examples of the types of uses and disclosures we may make in each of these categories.
- For Treatment. We may disclose your PHI to health care providers to facilitate your medical treatment or services, or to assist in connection with their payment activities and health care operations. For example, we may disclose your PHI to a health care provider when needed by the provider to render treatment to you, and we may disclose PHI to another covered entity to conduct health care operations in the areas of quality assurance and improvement activities, or accreditation, certification, licensing or credentialing. We also may disclose your PHI with other insurance carriers in order to coordinate benefits, if you or your family members have coverage through another carrier.
- For Payment. We will use or disclose your PHI to pay claims for services provided to you and to obtain stop-loss reimbursements or to otherwise fulfill our responsibilities for coverage and providing benefits. We may use and disclose your PHI to determine eligibility for Plan benefits, to facilitate payment for the treatment and services you receive from health care providers, to determine benefit responsibility under the Plan, or to coordinate Plan coverage.
- For Health Care Operations. We may use and disclose your PHI for Plan operations and to support our business functions. These uses and disclosures are necessary to manage the Plan and to monitor our quality of care. For example, we may use PHI to evaluate our Plan’s services, including the performance of our staff, and to respond to customer service inquiries from you.
- WE MAY USE AND DISCLOSE PERSONAL HEALTH INFORMATION ABOUT YOU FOR OTHER SPECIFIC PURPOSES
Disclosure to Health Plan Sponsor. PHI may be disclosed to another health plan maintained by Albright Care Services for the purpose of facilitating claims payments under that plan.
Individuals Involved in Your Care or Payment for Care. Unless you object, we may disclose your PHI to a family member or close personal friend, including clergy, who is involved in your care. Further, unless you object, we may disclose your PHI to your dependents listed on and covered under the Plan.
Disaster Relief. We may disclose your PHI to an organization assisting in a disaster relief effort.
As Required By Law. We will disclose your PHI when required by law to do so.
Public Health Activities. We may disclose your PHI for public health activities. These activities may include, for example
- reporting to a public health or other government authority for preventing or controlling disease, injury or disability, or reporting child abuse or neglect;
- reporting to the federal Food and Drug Administration (FDA) concerning adverse events or problems with products for tracking products in certain circumstances, to enable product recalls or to comply with other FDA requirements;
- to notify a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition or
- for certain purposes involving workplace illness or injuries.
Reporting Victims of Abuse. Neglect or Domestic Violence. If we believe that you have been a victim of abuse, neglect or domestic violence, we may use and disclose your PHI to notify a government authority if required or authorized by law, or if you agree to the report.
Health Oversight Activities. We may disclose your PHI to a health oversight agency for oversight activities authorized by law. These may include, for example, audits, investigations, inspections and licensure actions or other legal proceedings. These activities are necessary for government oversight of the health care system, government payment or regulatory programs, and compliance with civil rights laws.
Judicial and Administrative Proceedings. We may disclose your PHI in response to a court or administrative order. We also may disclose information in response to a subpoena, discovery request, or other lawful process; efforts will be made to contact you about the request or to give you an opportunity to obtain an order or agreement protecting the information.
Law Enforcement. We may disclose your PHI for certain law enforcement purposes, including as required by law to comply with reporting requirements; to comply with a court order, warrant, subpoena, summons, investigative demand or similar legal process; to identify or locate a suspect, fugitive, material witness, or missing person; when information is requested about the victim of a crime if the individual agrees or under other limited circumstances; to report information about a suspicious death; to provide information about criminal conduct occurring at the facility; to report information in emergency circumstances about a crime; or where necessary to identify or apprehend an individual in relation to a violent crime or an escape from lawful custody.
Research. We may allow PHI of employees of our Plan to be used or disclosed for research purposes provided that the researcher adheres to certain privacy protections. Your PHI may be used for research purposes only if the privacy aspects of the research have been reviewed and approved by a special Privacy Board or Institutional Review Board, if the researcher is collecting information in preparing a research proposal, if the research occurs after your death, or if you authorize the use or disclosure.
Coroners, Medical Examiners, Funeral Directors, Organ Procurement Organizations. We may release your PHI to a coroner, medical examiner, funeral director or, if you are an organ donor, to an organization involved in the donation of organs and tissue.
To Avert a Serious Threat to Health or Safety. We may use and disclose your PHI when necessary to prevent a serious threat to your health or safety or the health or safety of the public or another person. However, any disclosure would be made only to someone able to help prevent the threat.
Military and Veterans. If you are a member of the armed forces, we may use and disclose your PHI as required by military command authorities. We may also use and disclose PHI about foreign military personnel as required by the appropriate foreign military authority.
Workers’ Compensation. We may use or disclose your PHI to comply with laws relating to workers’ compensation or similar programs.
National Security and Intelligence Activities Protective Services for the Employee and Others. We may disclose PHI to authorized federal officials conducting national security and intelligence activities or as needed to provide protection to the Employee of the United States, certain other persons or foreign heads of states or to conduct certain special investigations.
Appointment Reminders. We may use or disclose PHI to remind you about appointments.
Treatment Alternatives. We may use or disclose PHI to inform you about treatment alternatives that may be of interest to you.
Health Related Benefits and Services. We may use or disclose PHI to inform you about health‑related benefits and services that may be of interest to you.
- YOUR AUTHORIZATION IS REQUIRED FOR ALL OTHER USES OF PERSONAL HEALTH INFORMATIONExcept as described in this Notice or required by law, we will use and disclose PHI only with your written Authorization. You may revoke your Authorization to use or disclose PHI in writing, at any time. If you revoke your Authorization, we will no longer use or disclose your PHI for the purposes covered by the Authorization, except where we have already relied on the Authorization.
- YOUR RIGHTS REGARDING YOUR PERSONAL HEALTH INFORMATIONYou have the following rights regarding your PHI at the facility:
Right to Request Restrictions. You have the right to request restrictions on our use or disclosure of your PHI for treatment, payment or health care operations. You also have the right to restrict the PHI we disclose about you to a family member, friend or other person who is involved in your care or the payment for your care. We are not required to agree to your requested restriction. However, if we do agree to the restriction, then we must adhere to the restriction.
Right of Access to Personal Health Information. You have the right to request, in writing, your medical or billing records or other written information that may be used to make decisions about your care. If you request copies of the records, we must provide you with copies within thirty (30) days of that request. We may charge a reasonable fee for our costs in copying and mailing your requested information.
Right to Request Amendment. You have the right to request the facility to amend any PHI maintained by the facility for as long as the information is kept by or for the facility. You must make your request in writing and must state the reason for the requested amendment. We may deny your request for amendment if the information:
- was not created by the Plan , unless the originator of the information is no longer available to act on our request;
- is not part of the PHI maintained by or for the Plan;
- is not part of the information to which you have a right of access; or
- is already accurate and complete, as determined by the Plan.
If we deny your request for amendment, we will give you a written denial including the reasons for the denial and the right to submit a written statement disagreeing with the denial.
Right to an Accounting of Disclosures. You have the right to request an “accounting” of our disclosures of your PHI. This is a listing of certain disclosures of your PHI made by the facility or by others on our behalf, but does not include disclosures for treatment, payment and health care operations, disclosures made pursuant to a signed and dated Authorization, or certain other exceptions. To request an accounting of disclosures, you must submit a request in writing, stating a time period beginning on or after April 14, 2004 that is within six years from the date of your request. An accounting will include, if requested: the disclosure date; the name of the person or entity that received the information and address, if known; a brief description of the information disclosed; a brief statement of the purpose of the disclosure or a copy of the authorization or request; or certain summary information concerning multiple similar disclosures. The first accounting provided within a 12 month period will be free; for further requests, we may charge you our costs.
Right to a Paper Copy of This Notice. You have the right to obtain a paper copy of this Notice, even if you have agreed to receive this Notice electronically. You may request a copy of this Notice at any time.
Right to Request Confidential Communications. You have the right to request that we communicate with you concerning personal health matters in a certain manner or at a certain location. For example, you can request that we contact you only at a certain phone number. We will accommodate your reasonable requests.
- COMPLAINTSIf you believe that your privacy rights have been violated, you may file a complaint in writing with the facility or with the Office of Civil Rights in the U.S. Department of Health and Human Services. To file a complaint with the facility, contact HR Services Manager, Privacy Officer for Health Plan, (570) 522-3880.We will not retaliate against you if you file a complaint.
- CHANGES TO THIS NOTICEWe will promptly revise and distribute this Notice whenever there is a material change to the uses or disclosures, your individual rights, our legal duties, or other privacy practices stated in this Notice. We reserve the right to change this Notice and to make the revised or new Notice provisions effective for all PHI already received and maintained by the facility as well as for all PHI we receive in the future. We will post a copy of the current Notice in the facility. In addition, we will provide a copy of the revised Notice to all employees.
- FOR FURTHER INFORMATIONIf you have any questions about this Notice or would like further information concerning your privacy rights, please contact HR Services Manager, Privacy Officer for Health Plan, (570) 522-3880.