IMPORTANT NOTICES
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HIPAA Privacy Notice
This Notice is provided as required by the Federal Health Insurance Portability and Accountability Act of 1996, as amended (“HIPAA”) and its regulations issued at 45 CFR Parts 160 through 164 (the “Privacy
Regulations”). It is for participants and beneficiaries in the (referred to as the “Plan”). You are entitled to receive a notice of our procedures for protecting the privacy of your health information. “Protected
Health Information” is information that identifies you and is related to your medical history for health care you receive or the payment for that care. We must follow the terms of the notice currently in effect.
This notice describes how we may use or disclose your Protected Health Information and your rights regarding the use and disclosure of that information. You may also receive privacy notices from others, such
as other health care plans, insurers (including HMOs) and providers about their use and disclosure of your health information.
HOW THE PLAN MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
The Plan may use and disclose your Protected Health Information for different purposes. The examples below illustrate the types of uses and disclosures we may make without your authorization for
treatment, payment and health care operations.
· Treatment. The Plan may disclose your Protected Health Information to assist your health care providers (doctors, pharmacies, hospitals and others) in your diagnosis and treatment. For example,
The Plan may disclose to one treating physician the name of another treating physician so that he or she can obtain records or other information needed for diagnosis or treatment.
· Payment. The Plan may use and disclose your Protected Health Information in order to pay for your covered health expenses. For example, we may use your Protected Health Information to enroll
you for coverage or to determine if a claim for benefits is covered under the Plan (e.g., if treatment is medically necessary).
· Health Care Operations. The Plan may use and disclose your Protected Health Information in order to perform Plan activities, such as quality assessment and improvement activities, reviewing
competence or qualifications of health care providers, underwriting, premium rating and other insurance activities relating to creating or renewing insurance contracts. Other activities include
disease management, case management, conducting or arranging for medical review, legal services and auditing functions, including fraud and abuse compliance programs, business planning and
development, business management and general administrative activities. For example, The Plan may use information about your claims to refer you to a disease management program.
· Plan Sponsor. The Plan discloses your medical information to , which sponsors the Plan, for Plan administration purposes that are described in the document that governs the specific Plan. The
Plan Sponsor will be required to certify to us that it will use your medical information in accordance with the Privacy Regulations.
· Enrolled Dependents and Family Members. The Plan will mail explanation of benefits forms and other mailings containing Protected Health Information to the address we have on record for the
employee who is enrolled in the health plan.
OTHER PERMITTED OR REQUIRED DISCLOSURES
· To Your Family Member, Other Relative or Close Personal Friend. The Plan may disclose Protected Health Information to a family member, other relative or close personal friend provided that
information is directly relevant to that person’s involvement in your health care or to notify them of your location, general condition or death. The Plan will not make any such disclosure unless you
are given a reasonable opportunity under the circumstances to object and did, in fact, object.
· As Required by Law. The Plan must disclose Protected Health Information about you when we are required to do so by law.
· Public Health Activities. The Plan may disclose Protected Health Information to public health agencies for reasons such as preventing or controlling disease, injury or disability. This includes
disclosures necessary to report product defects, to permit product recalls and to conduct post-marketing surveillance. Protected Health Information may also be used or disclosed if you have been
exposed to a communicable disease or are at risk of spreading a disease or condition, if authorized by law.
· Victims of Abuse, Neglect or Domestic Violence. The Plan may disclose Protected Health Information to government agencies about abuse, neglect or domestic violence if there is a reasonable
belief that you may be a victim of abuse, neglect to domestic violence. In that case, The Plan will promptly inform you that a disclosure has been or will be made unless that notice would cause a risk
of serious harm. For purposes of reporting child abuse or neglect, it is not necessary to inform the minor that such disclosure has been or will be made. Disclosure may generally be made to the
minor’s parents or other representatives although there may be circumstances under federal or state law when the parents or other representatives may not be given access to the minor’s
Protected Health Information.
· Health Oversight Activities. The Plan may disclose Protected Health Information to government oversight agencies (e.g., U.S. Department of Labor) for oversight activities authorized by law. This
includes uses or disclosures in civil, administrative or criminal investigations; inspections licensure or disciplinary actions (for example, to investigate complaints against providers); and other
activities necessary for appropriate oversight of government benefit programs.
· Judicial and Administrative Proceedings. The Plan may disclose Protected Health Information in response to a court or administrative order. The Plan may also disclose Protected Health
Information about you in certain cases in response to a subpoena, discovery request or other lawful process. In such case, The Plan will require satisfactory assurances that the requesting party has
made a good faith attempt to provide written notice to you, and the notice provided sufficient information about the proceeding to permit you to raise an objection and no objections were raised,
or if any were raised, that they were resolved in favor of disclosure by the court or tribunal.
12/2022
Aspire Health Partners is an Equal Opportunity
Employer