NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.
Our Legal Duty
We understand that information about you and your health is personal. We are committed to protecting your health information. We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to make available to you this notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices that are described in this notice while it is in effect. This notice takes effect April 14, 2003, and will remain in effect until we replace it.
We reserve the right to change our privacy practices and the terms of this notice at any time, provided such changes are permitted by applicable law. We reserve the right to make these changes effective for all health information that we maintain, including health information we created or received before we made the changes. Should we determine that a change to this notice is necessary; we shall promptly revise the notice and shall make available the amended version on our web site or upon request. You may request a copy of our notice at any time. For more information about our privacy practices, or for additional copies of this notice, please contact us using the information listed at the end of this notice.
How We May Use and Disclose Your Health Information
We use and disclose health information about you for treatment, payment, and health care operations.
Treatment: We may use or disclose your health information to a vision care provider or other health care provider in order to provide treatment to you.
Payment: We may use and disclose your health information to pay claims from physicians, vision care providers and other providers for services delivered to you that are covered by your vision care plan; to determine your eligibility for benefits; to evaluate medical necessity; to obtain premiums; and to issue explanations of benefits to participating providers within the vision care plan in which you participate. We may disclose your health information to a health care provider or entity subject to the federal Privacy Rules so they can obtain payment or engage in these payment activities.
Health Care Operations: We may use and disclose your health information in connection with our health care operations. Health care operations include:
- Determining our rates for your vision care plan
- Quality assessment and quality improvement activities
- Reviewing the competence or qualifications of vision care professionals, evaluating vision care provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities
- Medical review, legal services, and auditing, including fraud and abuse detection and compliance
- Business planning and development; and
- Business management and general administrative activities, including management activities relating to privacy, customer service, and resolution of internal grievances.
We may disclose your health information to another entity which has a relationship with you and is subject to the federal Privacy Rules, for their health care operations relating to quality assessment and quality improvement activities, reviewing the competence or qualifications of vision care professionals, or detecting or preventing health care fraud and abuse.
Business Associates: We may contract with third party service providers (known as “business associates” under the Privacy Rule) to perform various services on our behalf. Typically, these services come within the definitions of “payment” and “health care operations” discussed above. To perform these services, business associates will receive, create, maintain, use or disclose protected health information, but only after the business associates agree in writing to appropriately safeguard your protected health information.
On Your Authorization: You may give us written authorization to use your health information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those described in this notice.
To Your Family and Friends: We may disclose your protected health information to a family member, friend or other person to the extent necessary to help with your vision care or with payment for your vision care, unless you object or request a restriction (in accordance with the process described below under the heading “Restrictions”). We may use or disclose your name, location, and general condition or death to notify, or assist in the notification (including identifying or locating), a person involved in your care. If you are not present, or in the event of your incapacity or an emergency, we will disclose your health information based on our professional judgment of whether the disclosure would be in your best interest.
Your Employer or Organization Sponsoring Your Group Health Plan: We may disclose your health information and the health information of others enrolled in your group health care plan to the employer or other organization that sponsors your group health care plan to permit the plan sponsor to perform plan administration functions. For example, we may disclose the minimum necessary vision care claims information to the employer or other organization that sponsors your vision benefit for the purposes of obtaining payment for vision care services you received. Your employer or other organization sponsoring your Group Health Plan may contact us on your behalf concerning benefits, claims, coverage, etc. and we will provide the minimum necessary information to respond to the inquiry. Please see your group health plan document for a full explanation of the limited uses and disclosures that the plan sponsor may make of your health information in providing plan administration.
We may also disclose summary information about the enrollees in your group health plan to the plan sponsor to use to obtain premium bids for the vision care insurance coverage offered through your group health plan or to decide whether to modify, amend or terminate your group health plan. The summary information we may disclose summarizes claims history, claims expenses, or types of claims experienced by the enrollees in your group health plan.
Underwriting: We may receive your health information for underwriting, premium rating or other activities relating to the creation, renewal or replacement of a contract of vision care insurance or vision care benefits. We will not use or further disclose this health information for any other purpose, except as required by law, unless the contract of vision care insurance or vision care benefits is placed with us. In that case, our use and disclosure of your health information will only be as described in this notice. We are prohibited by law from using or disclosing genetic information for underwriting purposes.
Public Benefit: We may use or disclose your health information as authorized by law for the following purposes deemed to be in the public interest or benefit:
- As required by law
- For public health activities, including disease and vital statistic reporting, child abuse reporting, FDA oversight, and to employers regarding work-related illness or injury
- To report adult abuse, neglect, or domestic violence
- To health oversight agencies
- In response to court and administrative orders and other lawful processes
- To law enforcement officials pursuant to subpoenas and other lawful processes, concerning crime victims, suspicious deaths, crimes on our premises, reporting crimes in emergencies, and for purposes of identifying or locating a suspect or other person
- To coroners, medical examiners, and funeral directors
- To organ procurement organizations
- To avert a serious threat to health or safety
- In connection with certain research activities
- To the military and to federal officials for lawful intelligence, counterintelligence, and national security activities
- To correctional institutions regarding inmates; and
- As authorized by state worker’s compensation laws.
Health Related Services: We may use your health information to contact you with information about vision care related benefits and services or about treatment alternatives that may be of interest to you. We may disclose your health information to a business associate to assist us in these activities. We may use or disclose your health information to encourage you to purchase or use a product or service by face-to-face communication or to provide you with promotional gifts.
Access: You have the right to look at or get copies of your health information, with limited exceptions.
You may request that we provide copies in a format other than photocopies. We will use the format you request unless we cannot practicably do so. You must make a request in writing to obtain access to your health information. You may request access by sending us a letter to the address at the end of this notice. If you request copies, we will charge you a cost-based fee for staff time to copy your health information, copying supplies and postage if you want the copies mailed to you. If you request an alternative format, we will charge a cost-based fee for providing your health information in that format. If you prefer, we will prepare a summary or an explanation of your health information for a fee. Contact us using the information listed at the end of this notice for a full explanation of our fee structure.
Disclosure Accounting: You have the right to receive a list of instances in which we or our business associates disclosed your health information for purposes other than treatment, payment, health care operations, as authorized by you, and for certain other activities, up to three (3) years prior to your request. You must make a request in writing to obtain an accounting of all disclosures of your health information. We will provide you with the date on which we made the disclosure, the name of the person or entity to which we disclosed your health information, a description of the health information we disclosed, the reason for the disclosure, and certain other information. If you request this accounting more than once in a 12- month period, we may charge you a reasonable, cost based fee for responding to these additional requests. Contact us using the information listed at the end of this notice for a full explanation of our fee structure.
Restrictions: You have the right to request a restriction on our uses and disclosures of protected health information about you for treatment, payment or health care operations and/or to request a limit on disclosures of your protected health information to family members or friends who are involved in your care or the payment for your vision care or for notification purposes. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency). Any agreement to additional restrictions must be in writing signed by a person authorized to make such an agreement on our behalf. We will not be bound unless our agreement is so memorialized in writing. If we agree to a restriction, we can stop complying with the restriction after notifying you.
Confidential Communication: You have the right to request that we communicate with you about your health information by alternative means or to alternative locations. You must make your request in writing, and you must state that the information could endanger you if it is not communicated in confidence as you request. We must accommodate your request if it is reasonable, specifies the alternative means or location, and continues to permit us to collect premiums and pay claims under your vision care plan, including issuance of explanations of benefits to the Participating Provider of the vision care plan in which you participate. An explanation of benefits issued to the Participating Provider for vision care that you received for which you did not request confidential communications or about the subscriber or others covered by the vision care plan in which you participate may contain sufficient information to reveal that you obtained vision care for which we paid, even though you requested that we communicate with you about that vision care in confidence.
Amendment: You have the right to request that we amend your health information. Your request must be in writing, and it must explain why the information should be amended. We may deny your request if we did not create the information you want amended and the originator remains available or for certain other reasons. If we deny your request, we will provide you a written explanation. You may respond with a statement of disagreement to be appended to the information you wanted amended. If we accept your request to amend the information, we will make reasonable efforts to inform others, including people you name, of the amendment and to include the changes in any future disclosures of that information.
Electronic Notice: If you receive this notice on our web site or by electronic mail (e-mail), you may also request to receive this notice in written form. Please contact us using the information listed at the end of this notice to obtain this notice in written form.
Questions and Complaints
If you want more information about our privacy practices or have questions or concerns, please contact us using the information listed at the end of this notice. If you are concerned that we may have violated your privacy rights or you disagree with a decision we made about access to your health information or in response to a request you made to amend or restrict the use or disclosure of your health information or to have us communicate with you by alternative means or at alternative locations, you may make a complaint using the contact information listed at the end of this notice. You also may submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request. We support your right to the privacy of your health information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.
Physicians Eyecare Plan
ATTN: Privacy Office
48 Courtenay Drive
Charleston, SC 29403
Web Site: www.physicianseyecareplan.com
Effective date: This Notice of Privacy Practices is effective April 14, 2003.