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.
This Notice of Privacy
Practices describes how we may use and disclose your protected health information
to carry out payment or healthcare operations and for other purposes that are
permitted or required by law. It also describes your rights to access and
control your protected health information. “Protected health information” (PHI)
is information about you, including demographic information, that may identify
you and that relates to your past, present or future physical or mental health
condition and related healthcare services.
We are required to abide
by the terms of this Notice of Privacy Practices. We may change the terms of
our notice at any time. The new notice will be effective for all protected
health information (PHI) that we maintain at that time.
If you have questions
about any part of this Notice or if you want more information about the privacy
practices at Royal Neighbors of America, please contact the Privacy Compliance
Department at P.O. Box PO Box 10850, Clearwater, Florida 33757-8850 or (877)
815-8877.
How We May Use or Disclose Your Health Information.
The following categories
describe the ways that we may use or disclose your health information. For each
category of uses and disclosures, we will explain what we mean and present some
examples. Not every use or disclosure will be listed, however all the ways we
are permitted to use and disclose information will fall within one of the
categories.
Treatment, payment or healthcare operations.
Federal law permits Royal
Neighbors of America to use and disclose your PHI without your authorization or
consent for the purposes of payment and healthcare operations.
· Payment.
We may use or disclose
information about you to determine eligibility for plan benefits, obtain
premiums, facilitate payment for the treatment or services you receive from
healthcare Providers, determine plan responsibility for benefits, or to
coordinate benefits. For example, payment functions may include sharing PHI
with Medicare or other health plans for purposes of coordination of benefits;
reviewing PHI to determine medical necessity of services received; providing
PHI to vendors for the collection and payment of fees for Prescription Drug
Card benefits.
· Healthcare Operations.
Healthcare operations are
the basic business functions necessary to operate as an insurance plan. Some
examples of uses and disclosures permitted as part of healthcare operations
include but are not limited to, the disclosure of PHI for underwriting, premium
rating and other activities relating to plan coverage; conducting or arranging
for medical review, legal services, audit services, and fraud and abuse
detection programs. We may disclose PHI to consultants who provide legal,
actuarial and auditing services to the plan. Operations also include the use
and disclosure of PHI for business planning, management and general
administration of the plan. We will share your protected health information
with third party “business associates” that perform various activities (e.g.,
claim administration services) on behalf of the plan.
Other uses and disclosures permitted without
authorization.
Federal law also allows a
health plan to use and disclose PHI, without your authorization or consent, in
the following ways:
· To you or a personal
representative designated by you or designated by law to act for you.
· To the Secretary of
Health and Human Services (HHS) or any employee of HHS as part of an
investigation to determine our compliance with the Federal Privacy laws.
· To a health oversight
agency, such as the Insurance Commissioner’s office, to respond to inquiries or
investigations of the plan or requests to audit the plan.
· In response to a court
order, subpoena, discovery request or other lawful judicial or administrative
proceeding.
· As required for law
enforcement purposes. For example to notify authorities of a criminal act.
· As required to comply
with Worker’s Compensation or other similar programs established by law.
· As we otherwise may be
required by law.
The examples of uses and
disclosures listed above are not provided as an all-inclusive list of the ways
in which PHI may be used. They are provided to describe the general uses and
disclosures that may be made.
Uses and Disclosures Requiring an Opportunity to Agree or Disagree
· Unless you object, we
may disclose to a member of your family, a close friend or any person you
identify, your PHI that directly relates to that person’s involvement with the
payment related to your health care. If you are unable to agree or object to
this disclosure and in our professional judgment it is in your best interest to
do so, we will disclose only such information relevant to that individual’s
involvement in your care. For example, if we receive a telephone call regarding
the payment status of a claim submitted to us, we will release only the
information related to that particular claim.
Other uses and
disclosures of your PHI will only be made upon receiving your valid written
authorization. You may revoke an authorization at any time by providing written
notice to us that you wish to revoke an authorization. We will honor a request
to revoke as of the day it is received and to the extent that we have not
already used or disclosed your PHI in good faith with the authorization.
YOUR RIGHTS IN RELATION TO PROTECTED HEALTH INFORMATION
Right to Request
Restrictions on Uses and Disclosures.
You have the right to
request that the plan limit its uses and disclosures of PHI in relation to
treatment, payment or healthcare operations or not use or disclose your PHI for
these reasons at all. You also have the right to request the plan restrict the
disclosure of PHI to family members or personal representatives. Any such
request must be made in writing to the Privacy Compliance Office listed in this
Notice and must state the specific restriction and to whom the restriction
should apply.
The plan is not required
to agree to the restriction that you request. However, if it does agree to the
requested restriction, it may not violate that restriction except as necessary
to allow provision of emergency medical care to you.
Right to Request Confidential Communications.
You have the right to
request that communications involving PHI be provided to you at an alternative
location or by alternative means. The plan is required to accommodate any
reasonable request if the normal method of disclosure would endanger you and
that danger is stated in your request. Any such request must be made in writing
to the Privacy Compliance Office listed in this notice.
Right to Access Your Protected Health Information.
You have the right to
inspect and copy your PHI that is contained in a designated record set for as
long as the plan maintains the PHI. A designated record set may contain claim
information, premium records and any other records the plan has created in
making claim and coverage decisions relating to you. Federal law prohibits you
from accessing the following records: psychotherapy notes; information complied
in the reasonable anticipation of, or for use in a civil, criminal or
administrative action or proceeding; and PHI that is subject to a law that prohibits
access to that information. If your request for access is denied, you may have
a right to have that decision reviewed. Requests for access to your PHI should
be directed to the Privacy Compliance Office listed in this Notice.
Right to Amend Protected Health Information.
You have the right to
request that PHI in a designated record set be amended for as long as the plan
maintains the PHI. The plan may deny your request for amendment if it
determines that the PHI was not created by the plan, is not part of the
designated record set, is not information available for inspection, or that the
PHI is accurate and complete. If your request for amendment is declined, you
have the right to have a statement of disagreement included with the PHI. The
plan has the right to include a rebuttal to your statement, a copy of which
will be provided to you. Requests for amendment of your PHI should be directed
to the Privacy Compliance Office listed in this Notice.
Right to Receive an Accounting of Disclosures.
You have the right to
receive an accounting of all disclosures of your PHI that the plan has made, if
any, for reasons other than disclosures for treatment, payment or healthcare
operations, as described above, disclosures made to you or your personal
representative and disclosures made pursuant to a valid authorization received
from you. Your right to an accounting of disclosures applies only to PHI
created by the plan after April 14, 2003, and cannot exceed a period of six
years prior to the date of your request. Requests for an accounting of
disclosures of your PHI should be directed to the Privacy Compliance Office
listed in this Notice.
Right to Receive a Paper Copy of this Notice.
You have the right to
receive a paper copy of this Notice upon request. This right applies even if
you have previously agreed to accept this Notice electronically. Requests for a
paper copy of this Notice should be directed to the Privacy Compliance Office
listed in this Notice.
COMPLAINTS
If you believe that your
privacy rights have been violated, you may file a compliant with the plan or
your local Office for Civil Rights. The plan will not retaliate against you for
filing a complaint.
Complaints filed with the
plan should be filed in writing to:
Privacy Compliance Office
P.O. Box 10850
Clearwater, FL 33757-8850
For assistance in filing a complaint with the Office for Civil Rights call
toll-free:
(866) 627-7748
PRIVACY CONTACT INFORMATION
If you have any questions
regarding this Notice you may obtain additional information by writing to:
Privacy Compliance
Department
PO Box 10850
Clearwater, Florida 33757-8848
Or by calling
(877) 815-8877
EFFECTIVE DATE OF NOTICE
This Notice was published
and becomes effective no later than April 14, 2003.