THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
This document contains an important message about the information we collect from
you and about you. Please read it before filing it with your other important papers.
This document describes:
- The kind of information we collect.
- The ways that we protect this information.
- How we use and share this information.
- Your rights as a member about this information.
This document tells you that:
The Plan is required by federal and state law to protect the privacy of all personal
and nonpublic information we collect from our members.
We collect this information-name, address, date of birth, Social Security number
and the like-from enrollment applications, medical records, claim forms, and other
documents.
We also collect income and asset information from Medicaid and Medicare.
We don’t share any of the information we collect with anyone, except as permitted
by law.
We have internal safeguards to protect the information we collect.
If we need to share the information in a way other than the law permits, we will
do so only after getting the member’s written authorization.
We are permitted by law to share the information when administering benefits.
We are also permitted by law to share the information under the special circumstances
described in this booklet.
Questions about how we protect information may be directed in writing to us. See
page 6 for the mailing address for your plan, as well as the Member Service telephone
number and Web address for your plan.
For details, please read the entire document.
We respect the confidentiality of your health information and we will protect your
information in a responsible and professional manner. We are required by federal
and state laws to maintain the privacy of your health information and to send you
this notice.
This notice explains how we use information about you and when we can share that
information with others.
It also informs you about your rights with respect to your health information and
how you can exercise these rights.
We use security safeguards and techniques designed to protect your personal information.
We train our employees about our privacy policies and practices, and we limit access
to your information to only those employees who need it in order to perform their
business responsibilities. We do not sell information about our customers or former
customers.
Information We Collect
Examples of “information” or “health information” discussed in this notice can include:
- Information that we have created or received about your past, present, and future
medical conditions that could be used to identify you;
- Information about medical treatments you have received;
- Demographic information that could possibly be used to identify you.
This notice describes the privacy practices of Touchstone Health Plan
How We Use or Share Information
We may use or share information about you for purposes of payment, treatment, and
health care operations, including with our business associates.
For example:
- Payment: We may use your information to process and pay claims submitted
to us by you or your doctors and hospitals in connection with medical services provided
to you.
- Treatment: We may share your information with your doctors, hospitals, or
other providers to help them provide medical care to you. For example, if you are
in the hospital, we may give the hospital access to any medical records sent to
us by your doctor.
- Health Care Operations: We may use and share your information in connection
with our health care operations. These include, but are not limited to:
- Sending you a reminder regarding an appointment with your doctor or recommended
health screenings.
- Giving you information about alternative medical treatments and programs or about
health related products and services that you may be interested in. For example,
we might send you information about smoking cessation or weight loss programs.
- Rating our risk and determining our premium rates.
- Performing quality assessment and Improvement activities.
- Performing coordination of care and case management.
- Conducting activities to improve the health or reduce the health care costs of our
members. For example, we may use or share your information with others to help manage
your health care. We may also talk to your doctor to suggest a disease management
or wellness program that could help improve your health.
- Managing our business and performing General administrative activities, such as
Customer service and resolving internal grievances and appeals.
- Conducting medical reviews, audits, fraud and abuse detection, and compliance and
legal services.
- Conducting business planning and development.
- Reviewing the competence, qualifications, or performance of our network providers,
and conducting training programs, accreditation, certification, licensing and credentialing
activities.
- Business Associates: We may share your information with others who help us
conduct our business operations, provided they agree to keep your information confidential.
Other Ways We Use or Share Information
We may also use and share your information for the following other purposes:
- We may use or share your information with the employer or other health-plan sponsor
through which you receive your health benefits. We will not share detailed health
information with your benefits plan unless they promise to keep it protected.
- We may share your information with a health plan, provider, or health care clearinghouse
that participates with us in an organized health care arrangement. We will only
share your information for health care operations activities associated with that
arrangement.
- We may share your information with another health plan, provider or health care
clearinghouse that has or had a relationship with you for their health care operations.
The information would relate to quality assessment and improvement activities, reviewing
the competence or qualifications of health care professionals, or detecting or preventing
health care fraud and abuse.
- We may share your information with another health plan, provider or health care
clearinghouse that has or had a relationship with you for their health care operations.
The information would relate to quality assessment and improvement activities, reviewing
the competence or qualifications of health care professionals, or detecting or preventing
health care fraud and abuse.
- We may share your information with a family member, friend, or other person to the
extent necessary to help with your health care or payment for your health care.
We may also share information about your location, general condition, or death to
notify or help notify (including identifying and locating) a person involved with
your care or to help with disaster-relief efforts. Before we share this information,
we will provide you with an opportunity to object. If you are not present, or in
the event of your incapacity or an emergency, we will share your information based
on our professional judgment of whether the disclosure would be in your best interest.
State and Federal Laws Allow Us to Share Information
There are also state and federal laws that allow or may require us to release your
health information to others. We may share your information for the following reasons:
- We may report information to state and federal agencies that regulate us such as
the U.S. Department of Health and Human Services, the New York State Insurance Department
and the New York State Department of Health.
- We may share information for public health activities. For example, we may report
information to the Food and Drug Administration for investigating or tracking of
prescription drug and medical device problems.
- We may report information to public health agencies if we believe there is a serious
health or safety threat.
- We may share information with a health oversight agency for certain oversight activities
(for example, audits, inspections, licensure, and disciplinary actions).
- We may provide information to a court or administrative agency (for example, in
response to a court order, search warrant, or subpoena).
- We may report information for law enforcement purposes. For example, we may give
information to a law enforcement official for purposes of identifying or locating
a suspect, fugitive, material witness, or missing person.
- We may report information to a government authority regarding child abuse, neglect,
or domestic violence.
- We may share information with a coroner or medical examiner to identify a deceased
person, determine a cause of death, or as authorized by law. We may also share information
with funeral directors as necessary to carry out their duties.
- We may use or share information for procurement, banking or transplantation of organs,
eyes, or tissue.
- We may share information relative to specialized government functions, such as military
and veteran activities, national security and intelligence activities, and the protective
services for the President and others, and to correctional institutions and in other
law enforcement custodial situations.
- We may report information on job-related injuries because of requirements of your
state worker compensation laws.
- Under certain circumstances, we may share information for purposes of research.
Your Authorization
If one of the preceding reasons does not apply, we must get your written authorization
to use or disclose your health information. If you give us written authorization
and change your mind, you may revoke your written authorization at any time. Once
you give us authorization to release your health information, we cannot guarantee
that the person to whom the information is provided will not disclose the information.
We have an authorization form that describes the purpose for which the information
is to be used, the time period during which the authorization form will be in effect,
and your right to revoke authorization at any time. The authorization form must
be completed and signed by you or your duly authorized representative and returned
to us before we will disclose any of your protected health information.
You can obtain a copy of this form by contacting the Member Service phone number
on the back of your ID card. Special authorization forms may apply to certain records,
such as HIV/AIDS related records and psychotherapy notes.
Your Rights
The following are your rights with respect to the privacy of your health information.
If you would like to exercise any of the following rights, please contact us by
using the telephone number indicated on the back of your ID card.
Restricting Your Information
- You have the right to ask us to restrict how we use or disclose your information
for treatment, payment, or health care operations. You also have the right to ask
us to restrict information that we have been asked to give to family members or
to others who are involved in your health care or payment for your health care.
Please note that while we will try to honor your request, we are not required to
agree to these restrictions.
Confidential Communications for Your Information
- You have the right to ask to receive confidential communications of information
if you believe that you would be endangered if we send your information to your
current mailing address (for example, in situations involving domestic disputes
or violence). You can ask us to send the information to an alternative address or
by alternative means, such as by fax. We may require that your request be in writing
and specify the alternative means or location, as well as the reason for your request.
We will accommodate reasonable requests. Please be aware that the explanation of
benefits statement(s) that the plan issues to the contract holder or certificate
holder may contain sufficient information to reveal that you obtained health care
for which the plan paid, even though you have asked that we communicate with you
about your health care in confidence.
Inspecting Your Information
- You have the right to inspect and obtain a copy of information that we maintain
about you in your designated record set. A “designated record set” is the group
of records used by or for us to make benefit decisions about you. This can include
enrollment, payment, claims and case or medical management records. We may require
that your request be in writing.
We will respond to your request no later than 30 days after we receive it if we
maintain the information requested on-site. If we are unable to respond within 30
days, we may extend that time for no more than an additional 30 days provided that
we give you a written statement of the reasons for the delay and the date by which
we will respond. For information we do not maintain on-site, we will respond no
later than 60 days from the receipt of such a request. We may charge a fee for copying
information or preparing a summary or explanation of the information.
We may deny your request to inspect or obtain a copy of your information. If we
deny your request, we will notify you in writing and, if required by applicable
federal or state law, provide you with a right to have the denial reviewed.
You do not have the right to inspect or obtain a copy of the following types
of information:
- Information contained in psychotherapy notes;
- Information compiled in reasonable anticipation of, or for use in, a civil, criminal
or administrative action or proceeding; and
- Information subject to certain federal laws governing biological products and clinical
laboratories.
Amending Your Information
- You have the right to ask us to amend information we maintain about you in
your designated record set. We may require that your request be in writing and that
you provide a reason for your request. We will respond to your request no later
than 60 days after we receive it, unless an additional 30 days are required. If
we need this extension, we will notify you of the reasons for the delay and the
date by which we will complete action on your request.
If we make the amendment, we will notify you that it was made. We will also provide
the amendment to any person that we know has received your health information and
to other persons identified by you. We may deny your request for an amendment if
we did not create the information that you want amended and the originator remains
available or for certain other reasons. If we deny your request, we will notify
you in writing of the reason for the denial. The denial will explain your right
to file a written statement of disagreement. We have a right to reply to your statement.
However, you have the right to request that your written request, our written denial,
and your statement of disagreement be included with your information for any future
disclosures.
Accounting of Disclosures
- You have the right to receive an accounting of certain disclosures of your
information made by us during the six years prior to your request, beginning with
information collected on or after April 14, 2003. We may require that your request
be in writing. We will act on your request for an accounting within 60 days. We
may need additional time to act on your request, and, therefore, may take up to
an additional 30 days. Your first accounting will be free, and we will continue
to provide you with one free accounting upon request every 12 months. However, if
you request an additional accounting within 12 months of receiving your free accounting,
we may charge you a fee. We will inform you in advance of the fee and provide you
with an opportunity to withdraw or modify your request.
Please note that we are not required to provide an accounting of the following:
- Any information collected prior to April 14, 2003.
- Information disclosed or used for treatment, payment, and health care operations
purposes.
- Information disclosed to you or following your authorization.
- Information that is incidental to a use or disclosure otherwise permitted.
- Information disclosed to persons involved in your care or other notification purposes.
- Information disclosed for nation security or intelligence purposes.
- Information disclosed to correctional institutions or law enforcement officials.
- Information that was disclosed or used as part of a limited data set for research,
public health, or health care operations purposes.
Collecting, Sharing, and Safeguarding Your Financial Information
In addition to health information, the plan may collect and share other types of
information about you. We may collect and share the following types of personal
information:
- Name, address, telephone number and/or email address;
- Names, addresses, telephone numbers and/or email addresses of your spouse and dependents;
- Your social security number, age, gender, and marital status;
- Social security numbers, age, gender, and marital status of your spouse and dependents;
- Any information that we receive about you and your family from your applications
or when we administer your policy, claim, or account;
- If you purchase a group policy for your business, information to verify the existence,
nature, location, and size of your business.
We may share this information with our affiliates and with business associates that
perform services on our behalf. For example, we may share such information with
vendors that print and mail member materials to you on our behalf and with entities
that perform claims processing, medical review, and other services on our behalf.
These business associates must
maintain the confidentiality of the information. We may also share such information
when necessary to process transactions at your request and for certain other purposes
permitted by law. To the extent that such information may be or become part of your
medical records, claims history, or other health information, the information will
be treated like health information as described in this notice. As with health information,
we use security safeguards and techniques designed to protect your personal information.
We train our employees regarding our privacy policies and practices, and we limit
access to your information to only those employees who need it in order to perform
their business responsibilities. We do not sell information about our customers
or former customers.
Exercising Your Rights Complaints and Questions
- You have the right to receive a paper copy of this notice upon request at any
time. You can also view a copy of this notice on the Web site. See information
on next page. We must abide by the terms of this notice. However, 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) and to make such changes effective
for all health information we maintain. Before we make a material change to our
privacy practices, we will change this notice and provide the new notice to you
by direct mail and post it on our Web site.
- If you have any questions or would like further information about this notice
or about how we use or share information, you may write to the Compliance Department
or call Member Service. Please see the contact information below.
- If you believe that we may have violated your privacy rights, you may file a complaint
We will take no action against you for filing a complaint. Contact the Member
Service Department at the telephone number and hours of operation listed below.
You can also file a complaint by mail to the Compliance Department at the mailing
address listed below. You may also notify the Secretary of the U.S. Department of
Health and Human Services.
Contact Information
Please check the back of your ID card to call us or use the contact information
below.
Write to: Touchstone Health HMO, Inc., Attn: Compliance Department, PO Box 1265, White Plains, NY 10602
Call: 1-888-777-0204 (TTY: 1-877-867-5814) 8 AM to 8 PM, Monday to Friday (voicemail available on weekends)
Personal Information After You Are No Longer Enrolled
Even after you are no longer enrolled in any plan, we may maintain your personal
information as required to carry out plan administration activities on your behalf.
Our policies and procedures that safeguard that information against inappropriate
use and
disclosure still apply if you are no longer enrolled in the Plan.
Changes to this Notice
We are required to abide by the terms of this Notice of Privacy Practices as currently
in effect. We reserve the right to change the terms of the notice and to make the
new notice effective for all the protected health information that we maintain.
Prior to implementing any material changes to our privacy practices, we will promptly
revise and distribute our notice to our customers. In addition, for the convenience
of its members, but not as a substitute to the direct delivery described above,
the revised privacy notice will be posted on our Web site:
www.touchstoneh.com
