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.
The privacy of your personal and health information is important. You don't need to do anything unless you have a request or complaint.
We reserve the right to change our privacy practices and the terms of this notice at any time, as allowed by law. This includes the right to make changes in our privacy practices and the revised terms of our notice effective for all personal and health information we maintain. This includes information we created or received before we made the changes. When we make a significant change in our privacy practices, we will change this notice and send the notice to our health plan subscribers.
What is personal and health information? Personal and health information - from now on referred to as “information” - includes both medical information and individually identifiable information, like your name, address, telephone number, or Social Security number. The term “information” in this notice includes any personal and health information created or received by a healthcare provider or health plan that relates to your physical or mental health or condition, providing healthcare to you, or the payment for such healthcare. We protect this information in all formats including electronic, written and oral information.
How do we protect your information?
In keeping with federal and state laws and our own policy, we have a responsibility to protect the privacy of your information. We have safeguards in place to protect your information in various ways including:
• Limiting who may see your information
Limiting how we use or disclose your information
Informing you of our legal duties about your information
Training our associates about company privacy policies and procedures
How do we use and disclose your information?
We must use and disclose your information:
To you or someone who has the legal right to act on your behalf
To the Secretary of the Department of Health and Human Services
Where required by law.
We have the right to use and disclose your information:
To a doctor, a hospital, or other healthcare provider so you can receive medical care
For payment activities, including claims payment for covered services provided to you by healthcare providers and for health plan premium payments
For healthcare operation activities including processing your enrollment, responding to your inquiries and requests for services, coordinating your care, resolving disputes, conducting medical management, improving quality, reviewing the competence of healthcare professionals, and determining premiums
For performing underwriting activities. However, we will not use any results of genetic testing or ask questions regarding family history.
To your plan sponsor to permit them to perform plan administration functions such as eligibility, enrollment and disenrollment activities. We may share summary level health information about you with your plan sponsor in certain situations such as to allow your plan sponsor to obtain bids from other health plans. We will not share detailed health information to your plan sponsor unless you provide us your permission or your plan sponsor has certified they agree to maintain the privacy of your information.
To contact you with information about health-related benefits and services, appointment reminders, or about treatment alternatives that may be of interest to you if you have not opted out as described below
To your family and friends if you are unavailable to communicate, such as in an emergency
To your family and friends or any other person you identify, provided the information is directly relevant to their involvement with your health care or payment for that care. For example, if a family member or a caregiver calls us with prior knowledge of a claim, we may confirm whether or not the claim has been received and paid.
To provide payment information to the subscriber for Internal Revenue Service substantiation
To public health agencies if we believe there is a serious health or safety threat
To appropriate authorities when there are issues about abuse, neglect, or domestic violence
In response to a court or administrative order, subpoena, discovery request, or other lawful process
For law enforcement purposes, to military authorities and as otherwise required by law
• To assist in disaster relief efforts
For compliance programs and health oversight activities
To fulfill our obligations under any workers’ compensation law or contract
To avert a serious and imminent threat to your health or safety or the health or safety of others
For research purposes in limited circumstances
For procurement, banking, or transplantation of organs, eyes, or tissue
To a coroner, medical examiner, or funeral director.
Will we use your information for purposes not described in this notice?
In all situations other than described in this notice, we will request your written permission before using or disclosing your information. You may revoke your permission at any time by notifying us in writing. We will not use or disclose your information for any reason not described in this notice without your permission. The following uses and disclosures will require an authorization:
• Most uses and disclosures of psychotherapy notes
Sale of protected health information
What do we do with your information when you are no longer a member or you do not obtain coverage through us?
Your information may continue to be used for purposes described in this notice when your membership is terminated or you do not obtain coverage through us. After the required legal retention period, we destroy the information following strict procedures to maintain the confidentiality.
What are my rights concerning my information? The following are your rights with respect to your information. We are committed to responding to your rights request in a timely manner.
Access – You have the right to review and obtain a copy of your information that may be used to make decisions about you, such as claims and case or medical management records. You also may receive a summary of this health information. If you request copies, we may charge you a fee for each page, a per hour charge for staff time to locate and copy your information, and postage.
Adverse underwriting Decision – You have the right to be provided a reason for denial or adverse underwriting decision if your application for insurance is declined. *
Alternate Communications – You have the right to receive confidential communications of information in a different manner or at a different place to avoid a life threatening situation. We will accommodate your request if it is reasonable.
Amendment – You have the right to request an amendment of information we maintain about you if you believe the information is wrong or incomplete. We may deny your request if we did not create the information, we do not maintain the information, or the information is correct and complete. If we deny your request, we will give you a written explanation of the denial.
Disclosure – You have the right to receive a listing of instances in which we or our business associates have disclosed your information for purposes other than treatment, payment, health plan operations, and certain other activities. We maintain this information and make it available to you for a period of six years at your request. If you request this list more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests.
Notice – You have the right to receive a written copy of this notice any time you request.
Restriction – You have the right to ask to restrict uses or disclosures of your information. We are not required to agree to these restrictions, but if we do, we will abide by our agreement. You also have the right to agree to or terminate a previously submitted restriction.
What types of communications can I opt out of that are made to me?
Treatment alternatives or other health-related benefits or services
How do I exercise my rights or obtain a copy of this notice?
All of your privacy rights can be exercised by obtaining the applicable privacy rights request forms. You may obtain any of the forms by:
Contacting us at 1-219-987-4438 at any time
Accessing our website at fartsinc.com and going to the Privacy Practices link.
Emailing us at email@example.com
Send completed request form to:
Financial Arts, Inc. PO Box 19, DeMotte, Indiana 46310
What should I do if I believe my privacy has been violated?
If you believe your privacy has been violated in any way, you may file a complaint with us by calling us at 1-219-987-4438 anytime. You may also submit a written complaint to the U.S. Department of Health and Human Services, Office of Civil Rights (OCR). We will give you the appropriate OCR regional address on request. You also have the option to e-mail your complaint to OCRComplaint@hhs.gov. We support your right to protect the privacy of your personal and health information. We will not retaliate in any way if you elect to file a complaint with us or with the U.S. Department of Health and Human Services.
What will happen if my private information is used or disclosed inappropriately?
You have a right to receive a notice that a breach has resulted in your unsecured private information being inappropriately used or disclosed. We will notify you in a timely manner if such a breach occurs.
PRIVACY NOTICE CONCERNING FINANCIAL INFORMATION
We and our affiliates understand that the privacy of your personal information is important to you. We take your privacy seriously and your trust in our ability to protect your private information is very important to us. This notice describes our policy regarding the confidentiality and disclosure of personal financial information.
How do we collect information about you? We collect information about you and your family when you complete applications and forms. We also collect information from your dealings with us, our affiliates, or others. For example, we may receive information about you from participants in the healthcare system, such as your doctor or hospital, as well as from employers or plan administrators, credit bureaus, and the Medical Information Bureau.
What information do we receive about you?
The information we receive may include such items as your name, address, telephone number, date of birth, Social Security number, premium payment history, and your activity on our Website. This also includes information regarding your medical benefit plan, your health benefits, and health risk assessments.
Where will we disclose your information? We may share your information with affiliated companies and non-affiliated third parties, as permitted by law. We may also provide your information to other financial institutions with which we have joint marketing agreements in order to provide you with offers for products and services you may find of value or which are health-related.
What can I prevent with an opt-out disclosure?
You can prevent the disclosures to non-affiliated third parties that provide products and services not offered by us or where the non-affiliated company provides services related to your plan by requesting to opt-out of such disclosures. Your opt-out request will apply to all members or individuals covered under your identification number or member account.
Your opt-out request will continue to apply until you revoke your request or terminate your membership.
How do I request an opt-out?
At any time you can tell us not to share any of your personal information with affiliated companies that provide offers other than our products or services. If you wish to exercise your opt-out option, or to revoke a previous opt-out request, you need to provide the following information to process your request: your name, date of birth, and your member identification number. You can use any of the methods below to request or revoke your opt out:
Call us at 1-219-987-4438
E-mail us at firstname.lastname@example.org
Send your opt-out request to us in writing:
Financial Arts, Inc.
PO Box 19
DeMotte IN 46310
We follow all federal and state laws, rules, and regulations addressing the protection of personal and health information. In situations when federal and state laws, rules, and regulations conflict, we follow the law, rule, or regulation which provides greater protection.