HIPAA 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. IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT OUR PRIVACY OFFICE LISTED IN THIS NOTICE.
ORGANIZATIONS COVERED BY THIS NOTICE
This Notice applies to the privacy practices of North Carolina Mutual Life Insurance Company and Employers Direct Health, Inc. These organizations are each participants in an organized health care arrangement. As such, we may share your medical information and the medical information of others we service with each other as needed for payment activities or health care operations relating to our organized health care arrangement.
PERMITTED USES AND DISCLOSURES
Federal law allows use and disclosure of PHI, for the purposes of treatment, payment and health care operations, without your consent or authorization. Examples of the uses and disclosures that we may make under each section are listed below:
- Treatment. Treatment refers to the provision and coordination of health care by a doctor, hospital or other health care provider.
- Payment. Payment refers to the activities of collecting premiums and paying claims under the plan for health care services you receive. Examples of uses and disclosures under this section include the sending of PHI to an external medical review company to determine the medical necessity or experimental status of a treatment; sharing PHI with other insurers to determine coordination of benefits or settlement of subrogation claims; PHI in the billing, collection and payment of premiums and fees to plan vendors such as PPO Networks, Prescription Drug Card Companies and reinsurance carriers; and sending PHI to a reinsurance carrier to obtain reimbursement paid under the plan.
- Health Care Operations. Health Care Operations refers to the basic business functions necessary to operate. Examples of uses and disclosures under this section include conducting quality assessment studies to evaluate the plan’s performance or the performance of a particular network or vendor; the use of PHI in determining the cost impact of benefit design changes; the disclosure of PHI to underwriters for the purpose of calculating premium rates and providing reinsurance quotes; the disclosure of PHI to stop-loss or reinsurance carriers to obtain claim reimbursements; disclosure of PHI to plan consultants who provide legal, actuVerdana and auditing services to the plan; and use of PHI in general data analysis used in the long term management and planning for the plan and company.
Other Uses and Disclosures Allowed Without Authorization
Federal law also allows use and disclosure of PHI, without your consent or authorization, in the following situations:
- To you, as the covered individual.
- To a personal representative authorized by you to receive PHI or a personal representative designated by law, such as the parent or legal guardian of child, or the surviving family member(s) or representative(s) of the estate of a deceased individual.
- 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 HIPAA Privacy Rules.
- To a health oversight agency, such as the Department of Labor (DOL), the Internal Revenue Service (IRS) and the Insurance Commissioner''s Office, to respond to inquiries or investigations of the plan, requests to audit the plan, or to obtain necessary licenses.
- In response to a court order, subpoena, discovery request or other lawful judicial or administrative proceeding.
- As required by law enforcement purposes. For example, to notify authorities of a criminal act.
- As required to comply with Workers'' Compensation or other similar programs established by law.
- To the Plan Administrator, as necessary to carry out administrative functions of the plan such as evaluating renewal quotes for reinsurance of the plan, funding check registers, reviewing claim appeals, approving subrogation settlements and evaluating the performance of the plan.
The examples of permitted 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, in general, the types of uses and disclosures that may be made. You may request to revoke an authorization at any time by providing a written notice to our office.
- Right to request a restriction on certain uses and disclosures of your information as provided by 45 C.F.R. §164.522; however, it is not required to agree to a requested restriction.
- Right to obtain a paper copy of the notice of information practices upon request; this information is also available online at: www.edh.com.
- Right to inspect and obtain a copy of your health record as provided for in 45 C.F.R. §164.524.
- Right to request that your health records be amended as provided in 45 C.F.R. §164.526.
- Right to request communications of your health information by alternative means or at alternative locations. This right only applies if information could endanger you if it is not communicated by alternative means or to the alternative location.
- Right to receive an accounting of disclosures, if any, for reasons other than disclosures for treatment, payment, and health care operations, as described above, made of your health information as provided by 45 C.F.R. §164.528.
All requests to exercise any of the individual rights listed above must be received in writing to the Privacy Office listed in this Notice.
If you believe your privacy rights have been violated, or disagree with a decision we made about access to your medical information, you may file a complaint with the Privacy Contact listed in this Notice. You may also submit a written complaint to the Secretary of Health and Human Services. We support your right to privacy of your medical information and we will not retaliate in any way if you choose to file a complaint.
If you have any questions or complaints, please contact:
Employers Direct HealthRETURN TO TOP
HIPAA Privacy and Compliance Office
5050 Spring Valley Rd