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.
We are required by law to maintain the privacy of your protected health information (also referred to here as health information), to provide you with notice of our legal duties and privacy practices with respect to your health information, to notify you following a breach of unsecured health information, and to follow the terms of this notice of privacy practices (“Notice”) until we officially adopt a new Notice.
This Notice of Privacy Practices describes how we may use and disclose (share) your protected health information and your rights concerning this information. “Protected health information” 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 health care services.
Elderplan takes our members’ rights to privacy seriously and has set up a number of policies and practices to help make sure your health information is kept secure. These safeguards follow federal and state laws. For example, Elderplan employees must follow the Company’s privacy policies to protect health information. Another example is that company computers are password protected and equipped with security protection mechanisms.
The following categories show the different ways we may use and disclose (share) your health information.
Payment Purposes: We use and share your health information for payment purposes, such as paying providers and hospitals for covered services. Payment purposes also include activities such as: determining eligibility for benefits; reviewing services for medical necessity; obtaining premiums; and coordinating benefits.
Health Care Operations: We use and share your health information for health care operations. Examples of health care operations include coordinating/managing care; assessing and improving the quality of health care services; reviewing the qualifications and performance of providers; and conducting medical reviews and resolving grievances.
Treatment: We may share your health information with your health care provider (pharmacies, physicians, hospitals, etc.) so that the provider may treat you. For example, we may contact your physician concerning potential drug interactions or the availability of generic or formulary alternatives.
Provide Information to You: We may use your health information to provide you with information. This may include sending appointment reminders to your address, as well as giving you information about treatment options or other health-related products and services that may be of interest to you.
Persons Involved in Your Care: We may share your health information with a family member or someone else who is involved in your medical care or care payment as follows: (i) when you are present prior to the use or sharing and you agree; or (ii) when you are not present (or you are incapacitated or in an emergency situation) if, in the exercise of our professional judgment and in our experience with common practice, we determine that the sharing of your health information is in your best interests. In these cases, we will only share the health information that is directly relevant to the person’s involvement in your health care or payment related to your health care.
Personal Representatives: We may share your health information with your personal representative, if any. A personal representative has legal authority to act on your behalf in making determinations related to your health care or care payment. For example, we may disclose your health information to a durable power of attorney or legal guardian.
Business Associates: We may share your health information with business partners who help us conduct our business operations, such as an auditor or attorney, provided our business partner agrees to protect your information.
Health Information Exchanges: We may use or share your health information so we may participate in health information exchanges to facilitate the secure exchange of your electronic health information between and among several health care providers or other health care entities for your treatment, payment, or other health care operations purposes.
Health Oversight: We may share your health information with a health oversight agency for activities authorized by law, such as audits, investigations, inspections, licensure, and fraud and abuse investigations. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil laws.
Public Health Activities: We may share your health information with public authorities for the purposes of preventing or controlling the spread of disease, reporting child abuse or neglect, or certain other public health reasons.
Law Enforcement: We may share your health information as part of law enforcement activities: for example, in investigations of criminal conduct or of victims of crime; in response to search warrants or court orders; or in emergency circumstances, such as providing limited information to locate a missing person or report a crime.
Research Purposes: We may share your health information for research related to the evaluation of certain treatments or the prevention of disease or disability, if the research study meets privacy law requirements.
Fundraising Purposes: We may use or share your health information for our fundraising activities. If we do so, you will be informed of your right to opt out of further fundraising communications.
Workers’ Compensation: We may share your health information as necessary to comply with workers’ compensation laws.
As otherwise allowed or required by law: We may share your health information as required or allowed by law for many types of activities not listed above, including:
- to the Food and Drug Administration if necessary to report adverse events, product defects, or to participate in product recalls
- to authorized federal officials for national security purposes, such as protecting the President of the United States
- to a coroner, funeral director, or medical examiner (about deceased persons)
- to organ donation banks in connection with organ donations
- to disaster-relief organizations in emergency or disaster-relief situations
- to law enforcement or government officials to prevent or lessen a threat to you, another person, or the public and
- to law enforcement or government officials to provide legally-required notices of unauthorized access to or sharing of your health information
Additional Restrictions on Use and Disclosure: Certain federal and state laws may require special privacy protections that restrict the use and sharing of certain health information, including highly confidential information about you. “Highly confidential information” may include confidential information protected under federal and/or state laws governing the following types of information:
- Mental health;
- Alcohol and drug abuse; and
- Genetic information.
In the case of genetic information, we will not use or share your genetic information for underwriting purposes.
If a use or sharing of health information described above in this Notice is prohibited or otherwise limited by other laws that apply to us, our policy is to meet the requirements of the more stringent law.
Authorization: Except for uses and sharing of health information described in this Notice, we will use and share your health information only with a written authorization from you. Examples of uses and sharing of health information where a written authorization would be needed are when psychotherapy notes are involved and for marketing purposes or the sale of health information as these terms are defined by federal law.
Once you give us authorization to release your health information, we cannot guarantee that the person to whom the information is provided will not share the information. You may take back or “revoke” your written authorization at anytime in writing, except your revocation will not affect any actions we have already taken based on your earlier authorization. For information about how to authorize us to use or share your health information or about how to cancel an authorization, please see the “How to Exercise Your Rights” section below.
What Are Your Rights
You have certain rights with respect to your health information, including:
Request Restrictions: You have the right to ask us to restrict or limit how we use or share your health information. We will consider your request, but we are not required to agree to it. If we do agree, we will comply with the request unless the information is needed to provide you with emergency treatment. We cannot agree to limit disclosures that the law requires.
Confidential Communications: If you believe that sharing certain health information could endanger you, you have the right to ask us in writing to communicate with you at a special address or by a special means. For example, you may ask us to send explanations of benefits that contain your health information to a different address other than to your home, or you may ask us to call you at a specific phone number. We will agree to reasonable requests.
Inspect and Receive a Copy of Health Information: You have a right to inspect your health information that we have in our records and to receive a copy of it. This right is limited to your information that is used to make determinations about you, such as claim and enrollment records. If you want to review or receive a copy of these records, you must make the request in writing. We will act on your request in a timely manner as required by law. We may charge you a fee for the cost of copying and mailing the records. We may deny your access to certain information. If we do, we will give you the reason in writing. We will also explain how you may appeal the determination.
Amend Health Information: You have the right to ask us to amend health information about you that you believe is not correct or not complete. You must make this request in writing. You must also give us the reason you believe the information is not correct or complete. We may deny your request if we did not create the information, if the information is not part of the records we use to make determinations about you, if the information is something you would not be permitted to inspect or copy, or if the information is complete and accurate. If we deny your request to amend, we will notify you in writing of the reason for the denial and explain any additional amendment-related actions you may take.
Accounting of Disclosures: You have a right to receive a written accounting of certain types of disclosures of your health information we made to others in the last six-year period, based on the date you request the accounting. This accounting will list when we have shared your health information to others. We will provide the first list of disclosures you request at no charge. We may charge you for any additional lists you request during the following 12 months. You must tell us the time period you want the list to cover. Disclosures for the following reasons will not be included on the list:
- Disclosures for treatment, payment, or health care operations
- Disclosures for national security purposes
- Disclosures to correctional or law enforcement personnel
- Disclosures in emergency situations
- Disclosures that you have authorized
- Disclosures made directly to you
Notice of a Breach: You have a right to and will receive notification of breaches of your unsecure protected health information.
Right to This Notice: You have a right to receive a paper copy of this Notice.
How to Exercise Your Rights: To exercise any of the individual rights above or for more information, please call Member Services at 1-800-353-3765 (TTY: 1-800-662-1220) 8:00 a.m. to 8:00 p.m., 7 days a week, or write to:
Regulatory Compliance Department
55 Water Street 46th Floor, Suite 202
New York, NY 10041
Who to Contact with Questions or a Complaint: If you would like more information or an additional paper copy of this Notice, please contact Member Services at the number listed above. You may also download a copy from our website at www.elderplan.org. If you believe your privacy rights may have been violated, you have a right to complain to Elderplan by calling the Privacy Officer at 1-855-287-6810 (TTY: 1-800-662-1220) between the hours of 9:00 a.m. and 5:00 p.m., Monday through Friday, or writing to:
Regulatory Compliance Department
55 Water Street 46th Floor, Suite 202
New York, NY 10041
You also have a right to complain to the Secretary of U.S. Department of Health and Human Services.
We will not retaliate against you for filing a complaint.
The effective date of this Notice is August 1, 2013. This Notice replaces any other information you have previously received from us with respect to privacy of your health information. A revised Notice will apply to any health information we already have about you, as well as any health information we may get in the future. Whenever Elderplan makes an important change, we will send then-current Elderplan members a new Notice. In addition, we will publish the updated Notice on our website.