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HIPAA POLICY
 


HIPAA Information


CompBenefits takes pride in the fact that we are recognized as leaders in the dental and vision benefits markets. Our strength lies in our ability to administer dental and vision plans in an effective and innovative manner while safeguarding our members protected health information. We are committed to complying with the requirements and standards of the Health Insurance Portability and Availability Act of 1996 ("HIPAA"). Our commitment is demonstrated through our actions.

CompBenefits Board of Directors has appointed a Privacy Officer and Security Officer to develop, implement, maintain and provide oversight of our HIPAA compliance program.

CompBenefits has established a HIPAA Steering Committee to assist the Privacy Officer and the Security Officer with the implementation and maintenance of our HIPAA compliance program, as well as assist with the education and training our employees on the requirements and implications of HIPAA.

CompBenefits has created and implemented internal corporate wide policies and procedures to comply with the provisions of HIPAA.

CompBenefits has and will continue to conduct employee training and education in relation to HIPAA requirements.

CompBenefits has commenced dissemination of its Notice of Privacy Practices. Existing members were mailed a copy of the notice and new enrollees are provided with a copy with their member materials.

CompBenefits properly filed for the extension of the HIPAA standards for electronic health care transactions and code sets and began transmitting and receiving electronic-transactions in the HIPAA standard format before the October 16, 2003 deadline.

Should you have any questions regarding CompBenefits HIPAA compliance efforts please contact our Privacy Officer via e-mail at privacyofficer@compbenefits.com.



HIPAA and the use of Social Security Numbers


The following information is provided as a courtesy to our groups to address frequently asked questions about HIPAA and is not intended as interpretive or legal advice.

We have received a number of questions inquiring as to whether or not the Privacy Rules promulgated under the Health Insurance Portability and Accountability Act ("HIPAA") will prohibit the collection or use of an individual's Social Security number as an identifier for the group health plan.

Although the HIPAA Privacy Rules provide for the protection of individually identifiable information, which may include Social Security numbers, we do not believe that it is the intent of HIPAA to limit the collection or use of an individual's Social Security number for the following reasons. First, and most importantly, the HIPAA regulations do not specifically prohibit the use or disclosure of an individual's Social Security number. Secondly, since the individual's Social Security number falls under the same category as other individually identifiable information, such as the individual's name and address, it is equally protected under the HIPAA privacy and security requirements. Lastly, because of the fact that the Social Security number falls under the same category as other individually identifiable information, to prohibit the use or disclosure of the individual's Social Security number would also preclude the use of the individual's other identifiers, such as name and address, which is clearly not the intent of HIPAA.

We hope that this information has been helpful in your understanding of why we believe that the use of Social Security numbers is still allowed under the HIPAA regulations

If you should have any questions, please do not hesitate to contact our Privacy Officer at privacyofficer@compbenefits.com.



HIPAA Notice of Privacy Practices


Effective April 14, 2003


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.

Under the Health Insurance Portability and Accountability Act of 1996 (" HIPAA") we are required to maintain the privacy of your protected health information and provide you with notice of our legal duties and privacy practices with respect to such protected health information.

We are required to abide by the terms of the notice currently in effect. We reserve the right to change the terms of our notice at any time and to make the new notice provisions effective for all protected health information that we maintain. In the event that we make a material revision to the terms of our notice, you will receive a revised notice within 60-days of such revision. If you should have any questions or require further information, please contact our Privacy Officer at (770) 998-8936, ext. 87270 or toll free at (800) 342-5209.

How We May Use or Disclose Your Health Information


The following describes the purposes for which we are permitted or required by law to use or disclose your health information without your consent or authorization. Any other uses or disclosures will be made only with your written authorization and you may revoke such authorization in writing at any time.

Treatment: We may use or disclose your health information to provide you with medical treatment or services. For example, information obtained by a provider providing health care services to you will record such information in your record that is related to your treatment. This information is necessary to determine what treatment you should receive. Health care providers will also record actions taken by them in the course of your treatment and note how you respond.

Payment: We may use or disclose your health information in order to process claims or make payment for covered services you receive under your benefit plan. For example, your provider may submit a claim to us for payment. The claim form will include information that identifies you, your diagnosis, and treatment or supplies used in the course of treatment.

Health Care Operations: We may use or disclose your health information for health care operations. Health care operations include, but not limited to, quality assessment and improvement activities, underwriting, premium rating, management and general administrative activities. For example, members of our quality improvement team may use information in your health record to assess the quality of care that you receive and determine how to continually improve the quality and effectiveness of the services we provide.

Business Associates: There may be instances where services are provided to our organization through contracts with thirdparty "business associates". Whenever a business associate arrangement involves the use or disclosure of your health information, we will have a written contract that requires the business associate to maintain the same high standards of safeguarding your privacy that we require of our own employees and affiliates.

Required by Law: We will disclose medical information about you when required to do so by federal, state or local law.

Communication with Family or Friends: Our service professionals, using their best judgement, may disclose to a family member, other relative, close personal friend, or any other person you identify, health information relevant to that person's involvement in your care or payment related to your care.

Marketing: We may use or disclose your health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Research: We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.

Coroners, Medical Examiners and Funeral Directors: We may disclose health information to a coroner or medical examiner. We may also disclose medical information to funeral directors consistent with applicable law to carry out their duties.

Organ Procurement Organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

Fund Raising: We may contact you as part of a fund-raising effort.

Public Health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.

Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

Workers' Compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

To Avert a Serious Threat to Health or Safety: Consistent with applicable federal and state laws, we may use and disclose health information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.

Military and Veterans: If you are a member of the armed forces, we may disclose health information about you as required by military command.

Health Oversight Activities: We may disclose health information to a health oversight agency for activities authorized by law, including audits, investigations, inspections, and licensure.

Protective Services for the President, National Security and Intelligence Activities: We may disclose health information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations, or for intelligence, counterintelligence, and other national security activities authorized by law.

Law Enforcement: We may disclose health information when requested by a law enforcement official as part of law enforcement activities; investigations of criminal conduct; in response to court orders; in emergency circumstances; or when required to do so by law.

Inmates: We may disclose health information about an inmate of a correctional institution or under the custody of a law enforcement official to the correctional institution or law enforcement official.

Lawsuits and Disputes: We may disclose health information about you in response to a subpoena, discovery request, or other lawful order from a court.

Plan Sponsors: We may disclose health information about you to your plan sponsor to carry out plan administration functions that the plan sponsor performs upon certification by the plan sponsor that the plan documents have been amended as set forth under HIPAA regulations.

Your Rights Regarding Your Health Information


The following describes your rights regarding the health information we maintain about you. To exercise your rights, you must submit your request in writing to our Privacy Officer at 100 Mansell Court E., Suite 400, Roswell, GA 30076.

Right to Request Restrictions. You have the right to request that we restrict uses or disclosures of your health information to carry out treatment, payment, health care operations, or communications with family or friends. We are not required to agree to a restriction.

Right to Receive Confidential Communications. You have the right to request that we send communications that contain your health information by alternative means or to alternative locations. We must accommodate your request if it is reasonable and you clearly state that the disclosure of all or part of that information could endanger you.

Right to Inspect and Copy. You have the right to inspect and copy health information that we maintain about you in a designated record set. A "designated record set" is a group of records that we maintain such as enrollment, payment, and claims adjudication record systems. If copies are requested or you agree to a summary or explanation of such information, we may charge a reasonable, cost-based fee for the costs of copying, including labor and supply cost of copying; postage; and preparation cost of an explanation or summary, if such is requested. We may deny your request to inspect and copy in certain circumstances as defined by law. If you are denied access to your health information, you may request that the denial be reviewed.

Right to Amend. You have the right to have us amend your health information for as long as we maintain such information. Your written request must include the reason or reasons that support your request. We may deny your request for an amendment if we determine that the record that is the subject of the request was not created by us, is not available for inspection as specified by law, or is accurate and complete.

Right to Receive an Accounting of Disclosures. You have the right to receive an accounting of disclosures of your health information made by us in the six years prior to the date the accounting is requested (or shorter period as requested). This does not include disclosures made to carry out treatment, payment and health care operations; disclosures made to you; communications with family and friends; for national security or intelligence purposes; to correctional institutions or law enforcement officials; or disclosures made prior to the HIPAA compliance date of April 14, 2003. Your first request for accounting in any 12-month period shall be provided without charge. A reasonable, cost-based fee shall be imposed for each subsequent request for accounting within the same 12-month period.

Right to Obtain a Paper Copy. You have the right to obtain a paper copy of this Notice of Privacy Practices at any time.

How to File a Complaint if You Believe Your Privacy Rights Have Been Violated


If you believe that your privacy rights have been violated, please submit your complaint in writing to:

CompBenefits
Attn: Privacy Officer
100 Mansell Court East, Suite 400
Roswell, GA 30076

You may also file a complaint with the Secretary of the Department of Health and Human Services. You will not be retaliated against for filing a complaint.

CompBenefits' family of companies includes:
  • CompBenefits

  • CompBenefits Company

  • CompBenefits Dental and Vision Company

  • CompBenefits Insurance Company

  • CompBenefits Dental, Inc.

  • CompBenefits of Alabama, Inc.

  • CompBenefits of Georgia, Inc.

  • CompBenefits Direct, Inc.

  • American Dental Plan of North Carolina, Inc.

  • Denticare, Inc.

  • Texas Dental Plans

  • Ultimate Optical
The CompBenefits family of companies are affiliated companies and may share health information with each other as necessary to carry out treatment, payment, or health care operations.


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