The Jefferson Health Plan and your employer must internally use your protected health information to conduct business and to ensure that you are provided with the care and services to which you are entitled as a plan participant under one of The Jefferson Health Plan's sponsored employer programs. In some cases, we may disclose or share your protected health information with external individuals or organizations. In any case, The Jefferson Health Plan limits access to the protected health information used and disclosed to the minimum amount reasonably necessary. Upon your enrollment, The Jefferson Health Plan may use and disclose your protected health information for these purposes without your signed authorization. The purposes for which we may use and disclose your protected health information are described below.
The Jefferson Health Plan may use or disclose information about you to facilitate treatment by a physician or other health care provider. This includes the coordination of management of your health care with a third party that has already obtained your permission to have access to your protected health information.
The Jefferson Health Plan may use or disclose your health information for payment purposes. For example, we may use information regarding your medical procedures and treatment to process and pay claims, to determine whether services are medically necessary, or to otherwise certify services as covered under your employer's plan. We may also disclose such information to another health plan, which may have an obligation to process and pay claims on your behalf or to a health care provider from whom you have received medical services.
INFORMATION SENT TO YOU
As a plan participant covered under The Jefferson Health Plan umbrella, you may occasionally receive information from us or a third party about the care and services provided. These mailings may also contain information about services available to you as a plan participant under The Jefferson Health Plan, and these mailings may come from third party vendors authorized to do business with the consortium. Sometimes this includes your protected health information. Examples might include information about the payment of your claims, appointment reminders, or a case management call from a third party working with the consortium, such as Alere or Caremark. We may also send information to you about treatment alternatives or other health-related benefits and services that may be of interest to you.
INDIVIDUALS INVOLVED IN ARRANGING FOR YOUR CARE OR PAYMENT FOR YOUR CARE
With your approval, we may disclose your protected health information to a designated family member or others who may be helping you to arrange your care or arrange payment for your care. We may also disclose your protected health information to an individual or individuals who are legally authorized to act on your behalf, such as an individual to whom you have granted durable power of attorney. We may require the individual to furnish proof of such authorization before granting them access to your information. If you are unavailable, incapacitated, or facing an emergency medical situation, and in our professional judgment we determine that a limited disclosure may be in your best interest, we may share limited protected health information with such individuals without your approval. If you have designated a person to receive information regarding payment of the premium for your coverage, we will inform that person when your premium has not been paid. We may also disclose limited protected health information to a public or private entity that is authorized to assist in disaster relief efforts to locate a family member.
Certain aspects and components of our services are performed though contract with outside persons and organizations, such as auditing, case management, claims processing, legal services, stop loss coverage, underwriting, etc. At times it may be necessary for us to share some of your protected health information with one or more of these outside persons or organizations who assist the consortium in its day-to-day operations. In all cases, we require business associates to appropriately safeguard the privacy of your information and comply fully with the privacy practices described in this Notice.
OTHER USES AND DISCLOSURES
The Jefferson Health Plan is permitted and, in some cases, required by law to make the following additional uses or disclosures of your protected health information:
a. As required by law, The Jefferson Health Plan will disclose your protected health
information for any purpose when required to do so by federal, state, or local law.
b. To the Secretary of the U.S. Department of Health and Human Services or his/her
designee for investigations of HIPAA privacy compliance.
c. The Jefferson Health Plan may release your protected health information for public health
activities. These activities generally include the following:
• To prevent or control disease, injury, or disability
• To report births and deaths
• To report the abuse or neglect of children, elders, and dependent adults
• To report reactions to medications or problems with products
• To notify people of recalls of products they may be using
• To notify a person who may have been exposed to a disease or may be at risk for
contracting or spreading a disease or condition
• To notify the appropriate government authority if we believe a plan participant has
been the victim of abuse, neglect, or domestic violence. We will only make this
disclosure if you agree or when required by law.
• To notify the Food and Drug Administration if necessary to report adverse events,
product defects, or to participate in product recall
TO THE PLAN SPONSOR
Under certain circumstances, The Jefferson Health Plan may release your protected health information to your plan sponsor. The "plan sponsor" is generally your employer or the entity who funds your group health care program. The plan sponsor may need your information for such things as obtaining premium bids from The Jefferson Health Plan or another health plan. As part of The Jefferson Health Plan, your plan sponsor has already agreed to a number of legally required conditions designed to ensure that your information remains protected. For example, your plan sponsor must certify that the information provided will be maintained in a confidential manner and not be used for employment-related decisions or for other employee benefit determinations. The plan sponsor must also describe in advance the need for the information and limit access to the information to those employees who require it to perform the job function described. When feasible, the plan sponsor must return or destroy all copies of your protected health information when it is no longer needed.
HEALTH OVERSIGHT COMMITTEE
The Jefferson Health Plan may disclose your protected health information to a health oversight agency for activities authorized by law. These oversight activities include audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights law.
LAWSUITS AND DISPUTES
If you are involved in a lawsuit or a dispute, The Jefferson Health Plan may disclose your protected health information in response to a court or administrative order. The Jefferson Health Plan may also disclose your protected health information in response to subpoenas, discovery inquiries, or other lawful processes by someone else involved in the dispute, but only if efforts have been made to tell you about the request (which may include written notice to you) or to obtain an order protecting the information requested.
The Jefferson Health Plan may release protected health information if asked to do so by a law enforcement official:
• in response to a court order, subpoena, warrant, summons, or similar process.
• to identify or locate a suspect, fugitive, material witness, or missing person.
• to disclose information about the victim of a crime if, under certain limited circumstances,
we are unable to obtain the person's agreement.
• as related to a death we believe may be the result of criminal conduct.
• as required by law to report wounds and injuries or crimes.
• in certain situations where a plan participant is an inmate in a correctional institution.
CORONERS, MEDICAL EXAMINERS, AND FUNERAL DIRECTORS
The Jefferson Health Plan may release your protected health information to a coroner or medical examiner to identify a deceased person or determine the cause of death. The Jefferson Health Plan may also release your protected health information to funeral directors, consistent with applicable law, as necessary to carry out their duties with respect to the decedent.
ORGAN AND TISSUE DONATION
The Jefferson Health Plan may use or disclose your protected health information to organ procurement organizations for the purpose of facilitating organ, eye, or tissue donation and transplantation.
Under certain circumstances, The Jefferson Health Plan may use and disclose your protected health information for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process that evaluates a proposed research project and its use of medical information. Information for research is not disclosed until the research project is approved. We may, however, disclose your medical information to people preparing to conduct a research project to help them look for patients with specific medical needs, so long as the medical information they review does not leave the possession of The Jefferson Health Plan.
NATIONAL WORKERS' COMPENSATION
The Jefferson Health Plan may release your protected health information to workers' compensation agencies if necessary for your workers' compensation benefit determination.
YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION
RIGHT TO REQUEST RESTRICTIONS
You have the right to request restrictions on the uses and disclosures of your protected health information for treatment, payment, or health care operations. Restriction request forms are available from your employer or from The Jefferson Health Plan website. Your request must include (1) the information you want to limit, (2) whether you want to limit our use, disclosure, or both, and (3) to whom you want the limits to apply; for example, disclosures to your spouse. You or your authorized representative must sign restrictions. We are not required to agree to your restriction request. We retain the right to terminate an agreed-upon restriction if we believe such termination appropriate. In the event of termination by us, we will notify you of such termination. You also have the right to terminate in writing or verbally any agreed-upon restrictions by sending such termination notice to your employer or to The Jefferson Health Plan.
RIGHT TO AN ACCOUNTING OF DISCLOSURES
You have the right to receive an accounting of certain disclosures of your protected health information. The Jefferson Health Plan is not required to track and account for the following types of disclosures:
• Disclosures made for the purposes of treatment, payment,or operations
• Disclosures made to you or your authorized representative
• Disclosures to an individual involved in arranging for your care or arranging payment for
• Disclosures made in accordance with an authorization you had previously signed and agreed
• Certain disclosures that we may legally be required to keep from you, such as disclosures to
law enforcement officials in response to a legally obtained warrant.
If you would like an accounting of any disclosures of your protected health information that does not fall into the categories listed above, you must submit a written request signed by you or your authorized representative to your employer or to The Jefferson Health Plan.
CONFIDENTIAL AND ALTERNATIVE COMMUNICATIONS
As a plan participant covered by an employer sponsoring their health care plan under The Jefferson Health Plan, you may occasionally receive information from us about the care and services we provide. Sometimes this includes your protected health information. You have the right to request that The Jefferson Health Plan make reasonable accommodations for you to receive such communications by alternative means or at alternative locations. For example, you can request to have letters sent to a particular address that may be different from your normal home mailing address. You may also request that The Jefferson Health Plan restrict access and disclosure of your protected health information to specific individuals involved in arranging for your care or arranging payment for your care. Forms for requesting confidential communications are available from Member Service or from The Jefferson Health Plan website. Your request for confidential or alternative communications must be in writing, signed by you or your authorized representative. We are not required to agree to your request unless you clearly state that the disclosure of all or part of the information in question could place you or someone else in danger. You also have the right to request that we not send you any future marketing materials, and we will use our best efforts to honor such requests.
RIGHT TO INSPECT AND COPY
You have the right to copy and/or inspect most of the protected health information we retain on your behalf. All requests for access must be made in writing and signed by you or your authorized representative. You may obtain an access request by contacting your employer. We may charge you for a copy of the information. We may also charge for postage if you request a mailed copy and may charge for preparing a summary of the requested information if you request a summary.
RIGHT TO AMEND
If you believe the protected health information we maintain about you is incomplete or incorrect, you have the right to ask The Jefferson Health Plan or your employer to amend the records maintained. All amendment requests must be in writing and signed by you or your authorized representative. Your request for an amendment must state why you believe the records are incomplete or inaccurate. We are not obligated to make all requested amendments, but will give each request careful consideration. We may deny your request if you ask us to amend information that:
a. was not created by us, unless the person or entity that created the information is no longer
available to make the amendment, and we can confirm that the amendment is appropriate.
b. is not part of the protected health information kept by or for The Jefferson Health Plan.
c. is not part of the information you would be permitted to inspect and copy.
d. is accurate and complete.
The Jefferson Health Plan may send a copy of the newly amended record to any business associate or other entity who may have the older, inaccurate information.
If you believe your privacy rights have been violated, you can file a complaint. Your complaint must be in writing and sent to your employer or The Jefferson Health Plan. We will investigate your complaint and send a written notice to you with a response to your complaint. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services in Washington, D.C., in writing within 180 days of a violation of your rights. The Jefferson Health Plan encourages you to tell us if you believe your privacy rights were violated.
The Jefferson Health Plan has internal policies, processes, and procedures in place which all employees must follow to ensure protection of protected health information whether oral, written, or electronic.
All persons handling protected health information participate in annual educational sessions to ensure they maintain a current knowledge of and comply with these policies.