
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 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 third-party "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.