Effective Date:
HEALTH MANAGEMENT
BENEFITS PLAN FOR THE EMPLOYEES OF THE TOWN OF
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 Dale Johnson at 919-469-4073.
Who Will Follow This Notice
This
Notice describes the medical privacy practices of the
Health Management Benefits Plan for the Employees of the Town of
Our Pledge Regarding Medical
Information
We
understand that medical information about you and your health is personal, and
we are committed to protecting that information. As part of that protection, we have created a
record of your health care claims under the Plan. This Notice applies to all of the medical
records the Plan maintains about you.
Your personal doctor or personal health care provider may have different
policies or notices regarding the uses and disclosures of your medical
information which may have been created by that doctor or health care provider.
This
Notice tells you about the ways in which the Plan may use or disclose medical
information about you. It also describes
the Plan’s privacy obligations to you and your rights regarding the use and
disclosure of your medical information.
The
Plan is required by HIPAA to:
·
make sure that
medical information that identifies you is kept private;
·
give you this
Notice of the Plan’s legal duties and privacy practices with respect to medical
information about you; and
·
follow the terms of this Notice until it is changed. If it is changed, you will receive a copy of
the new Notice as long as the Plan keeps personalized health information about
you.
How the Plan May Use and Disclose Medical Information About You
The
following categories describe different ways that the Plan uses and discloses
medical information about you. For each
category of uses or disclosures, we will explain what we mean and present some
examples. Obviously, we cannot list
every possible use or disclosure which exists, but we will try to list the
important ones. All of the ways the Plan
is permitted to use and disclose information will fall within one of the
categories.
Your
Treatment. The first way the Plan may use or disclose
medical information about you is to help you with medical treatment or
services. The Plan may disclose medical
information about you to providers, including doctors, nurses, technicians,
medical students, or other hospital personnel who are involved in taking care
of you. For example, the Plan might
disclose information about your prior prescriptions to a pharmacist to
determine if a new prescription could cause health problems because it
conflicts with prior prescriptions.
Payment
of Your Claims. The Plan may use or disclose medical
information about you to determine if you are eligible for Plan benefits, to
pay for treatment or services you receive from health care providers, to
determine benefit responsibility under the Plan, or to coordinate Plan coverage
with other plans. For example, the Plan
may tell your health care providers about your medical history to determine if
a particular treatment is experimental, investigational, or medically
necessary, or to determine if the Plan will cover the treatment. The Plan may also share medical information
with a utilization review or precertification service provider. In addition, the Plan may share medical
information with another organization to help determine if a claim should be
paid or if another person or plan should be responsible for the claim.
Health
Care Operations. The Plan may use or disclose medical
information about you for other Plan operations. These uses and disclosures are necessary to
run the Plan. For example, the Plan may use medical information to conduct
quality assessment or improvement activities; to determine the cost of premiums
or conduct activities relating to Plan coverage; to submit claims for stop-loss
coverage; to conduct or arrange for medical review, legal services, audit
services, or fraud and abuse detection programs; and to predict the cost of
future claims or manage costs.
As Required By Law. The Plan will
disclose medical information about you when required to do so by federal, state
or local law. For example, the Plan may
disclose medical information when required by a court order in a lawsuit such
as a malpractice action.
To
Avert a Serious Threat to Health or Safety. The Plan may use or
disclose medical information about you when necessary to prevent a serious
threat to your health or safety, or to the health and safety of the public or
another person. Any disclosure, however,
would only be to someone able to help prevent the threat. For example, the Plan may disclose medical
information about you in a proceeding concerning the license of a doctor or
nurse.
Special Situations
Disclosure to Town of
Disclosures to Provide You With
Information. The Plan or its agents may contact you to
remind you about appointments or provide information about treatment
alternatives or other health-related benefits and services that may be of
interest to you.
Organ
and Tissue Donation. If you are an organ donor, the Plan may
release your medical information to organizations that handle organ procurement
or organ, eye or tissue transplants, or to an organ donation bank to help with
organ or tissue donation.
Military
and Veterans. If you are a member of the armed forces, the
Plan may release medical information about you as required by the
military. The Plan may also release
medical information about foreign military personnel to the appropriate foreign
military authority.
Workers’
Compensation. The Plan may release medical information
about you for workers’ compensation or similar programs. These programs provide benefits for
work-related injuries or illness.
Public
Health Risks. The Plan may disclose medical information
about you for public health purposes.
This includes disclosures:
§
to prevent or
control disease, injury or disability;
§
to report
births and deaths;
§
to report
child abuse or neglect;
§
to report
reactions to medications or problems with products;
§
to notify
people of recalls of products they may be using;
§
to notify a
person who may have been exposed to a disease or may be at risk for contracting
or spreading a disease or condition;
§
to notify the appropriate government authority if the Plan
believes a patient has been the victim of abuse, neglect or domestic
violence. The Plan will only make this
disclosure if you agree or if required or authorized by law.
Health
Oversight Activities. The Plan may disclose medical information to
a government health agency for activities authorized by law. These activities include, for example,
audits, investigations, inspections, and licensing. These activities are necessary for the
government to monitor the health care system, government programs, and to
comply with civil rights laws.
Lawsuits
and Disputes. If you are involved in a lawsuit or a
dispute, the Plan may disclose medical information about you in response to a
court or administrative order. The Plan
may also disclose medical information about you in response to a subpoena,
discovery request, or other lawful demand by someone else involved in the
dispute, but only if efforts have been made to tell you about the request or to
obtain an order protecting the information requested.
Law
Enforcement. The Plan may release medical information if
asked to do so by a law enforcement official:
§
in response to
a court order, subpoena, warrant, summons or similar court papers;
§
to identity or
locate a suspect, fugitive, material witness, or missing person;
§
about the
victim of a crime even if, under certain limited circumstances, the Plan is
unable to obtain your agreement;
§
about a death
the Plan believes may be the result of criminal conduct;
§
about criminal
conduct at a hospital; or
§
in emergency circumstances to report a crime or the location
of a crime or crime victims; or the identity, description or location of the
person who committed the crime.
Coroners,
Medical Examiners and Funeral Directors. The Plan may release
medical information to a coroner or medical examiner. This may be necessary, for example, to
identify someone who has died or to determine the cause of death. The Plan may also release medical information
about individuals to funeral directors as necessary to carry out their duties.
National
Security and Intelligence Activities. The Plan may release
medical information about you to authorized federal officials for intelligence,
counterintelligence, and other security activities authorized by law.
Inmates. If you are an inmate
of a correctional institution or under the custody of a law enforcement
official, the Plan may release medical information about you to the
correctional institution or law enforcement official. This release may be necessary (1) for the
institution to provide you with health care; (2) to protect your health and
safety or the health and safety of others; or (3) for the safety and security
of the correctional institution.
Your Rights
Regarding Medical Information About You
You
have the following rights regarding medical information the Plan maintains
about you:
Right
to Inspect and Copy. You have the right to inspect and copy
medical information that may be used to make decisions about your Plan
benefits. To do so, you must submit your
request in writing to Valiria Willis, Director of
Human Resources, Town of
The
Plan may deny your request to inspect and copy your information in certain circumstances. In most cases, if you are denied access to
medical information, you may request that the denial be reviewed.
Right
to Amend. If you feel that medical information the Plan
has about you is incorrect or incomplete, you may ask the Plan to amend the
information. You have the right to
request an amendment of your information as long as the information is kept by
or for the Plan.
To
request an amendment, your request must be made in writing and submitted to Valiria
Willis, Director of Human Resources, Town of
The Plan may deny
your request for an amendment if it is not in writing or does not include a
reason to support the request.
In addition, the Plan
may deny your request if you ask to amend information that:
§
is not part of
the medical information kept by or for the Plan;
§
was not
created by the Plan, unless the person or entity that created the information
is no longer available to make the amendment;
§
is not part of
the information which you would be permitted to inspect and copy; or
§
is accurate and complete.
Right
to an Accounting of Disclosures. You have the right
to request an accounting of the prior disclosures of your health information if
the disclosure was made for any purpose other than treatment, payment, or
health care operations.
To
request this list or accounting of disclosures, you must submit your request in
writing to Valiria Willis, Director of Human
Resources, Town of
Right
to Request Restrictions. You have the right to request a restriction
or limitation on medical information the Plan uses or discloses about you for
treatment, payment or health care operations. You also have the right to
request a limit on the medical information the Plan discloses about you to
someone who is involved in your care or the payment for your care, such as a
family member or friend. For example,
you could ask that the Plan not use or disclose information about a surgery you
had.
Despite
this, the Plan is not required to agree to your request.
To
request restrictions, you must make your request in writing to Valiria Willis,
Director of Human Resources, Town of
Right
to Request Confidential Communications. You have the right to
request that the Plan communicate with you about medical matters in a certain
way or at a certain location. For example, you can ask that the Plan only
contact you at work or by mail.
To
request confidential communications, you must make your request in writing to Valiria Willis, Director of Human Resources, Town of
Right
to a Paper Copy of This Notice. You have the right
to a paper copy of this Notice. You may
ask the Plan to give you a copy of this Notice at any time. Even if you have agreed to receive this
Notice electronically, you are still entitled to a paper copy of this
Notice. To obtain a paper copy of this
Notice, contact Dale Johnson, Employee Benefits Manager, Town of
Changes to This Notice
The
Plan reserves the right to change this Notice in the future, and to make the
revised or changed Notice effective for medical information the Plan already
has about you as well as any information it receives in the future. You will receive a copy of the changed Notice
in the same manner that you received this Notice. The Notice will contain the effective date on
the first page in the top right-hand corner.
Complaints
If
you believe your privacy rights have been violated, you may file a complaint
with the Plan or with the Secretary of the United States Department of Health
and Human Services. To file a complaint
with the Plan, contact Valiria Willis, Director of Human
Resources, Town of
Other Uses of Medical Information
Other
uses and disclosures of medical information not covered by this Notice or the
laws that apply to the Plan will be made only with your written
permission. This written permission is
called an “Authorization.” If you
provide the Plan with an Authorization to use or disclose medical information
about you, you may revoke that Authorization, in writing, at any time. If you revoke your Authorization, the Plan
will no longer use or disclose medical information about you for the reasons
covered by your written Authorization.
You understand that the Plan is unable to take back any disclosures it
has already made with your Authorization, and that the Plan is required by law
to retain records of the care that it has provided to you.