Privacy Notice
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.
Who We Are:
This Notice sets forth and describes the privacy practices of the
SSDC-League Health Fund. It only applies to the SSDC-League Health Fund
services that are furnished to you and administered directly by the Fund
(i.e., only the Medical Spending Account and Optical Benefit claims and
benefits), located at 1501 Broadway, Suite 1701, New York, NY 10036.
The SSDC-League Health Fund’s Privacy Obligations:
The SSDC-League Health Fund (“the Fund”) is required by the Health
Insurance Portability and Accountability Act of 1996 (“HIPAA”) to
maintain the privacy of your Protected Health Information (“PHI”).
Generally, PHI includes information (including demographic information)
which is created or received by the Fund, relates to your physical or
mental health or condition, the provision of health care to you, or the
payment for such health care and which could reasonably be used to
identify you. The Fund is also required to provide you with this Notice
of our legal duties and privacy practices with respect to your PHI. This
Notice covers any PHI that is maintained by the Fund. When we use and
disclose your PHI we are required to abide by the terms of the Notice as
currently in effect.
How the SSDC-League Health Fund May Use and Disclose Your PHI:
Under certain circumstances, the Fund must obtain your written
authorization in order to use and/or disclose your PHI (you will be
informed if such circumstances arise). However, no authorization is
normally required when we use or disclose your PHI to you or for the
following purposes: Treatment, Payment and Health Care Operations
Treatment: Although the Fund does not provide treatment, we may
use and disclose PHI to assist or otherwise support your health care
treatment. For example, PHI may be disclosed to health care providers
including but not limited to physicians, nurses or other hospital
personnel in order to assist such providers in treating you.
Payment: We may use and disclose your PHI in order to make
payment for any medical care that you receive. We may also use and
disclose PHI to process any claims for your health care, to determine
your eligibility for benefits, to determine the medical necessity of a
particular treatment, to determine issues related to coverage, and to
coordinate benefits with any other health plans.
Health Care Operations: Under certain circumstances, we may use
and disclose your PHI in order to conduct health care operations, which
include quality assessment and improvement activities which are designed
to improve the quality and/or cost effectiveness of the services
provided to you and internal business management and administrative
activities and/or planning and development, as well as for the purpose
of health care fraud and abuse detection or compliance. Under certain
circumstances, we may also use or disclose your PHI to inform you about
possible treatment alternatives or to provide you with information about
health-related benefits and services.
Other Permissible or Required Disclosures
To the Board of Trustees: We may disclose your PHI to the sponsor of
the Fund, the SSDC-League Health Fund’s Board of Trustees, for purposes
related to payment and health care operations. In particular, PHI may be
disclosed to the Board of Trustees, as is necessary, in connection with
appeals or other due process considerations relating to the provision or
denial of benefits (including where an individual directly contacts the
Board of Trustees with respect to a claim for benefits).
To Business Associates: We may disclose your PHI to entities
which perform or assist in performing services involving PHI for or on
behalf of the Fund, as long as the Fund obtains satisfactory assurances
that the business associate will appropriately safeguard the
information.
Relatives, Close Friends and Other Care Givers: Unless you notify
us that you object, we may under certain circumstances exercise our
professional judgment to determine whether a disclosure to a family
member, close friend or other caregiver is in your best interests. If we
disclose your PHI to a family member, close friend or other caregiver,
we would disclose only the PHI that is directly relevant to the person's
involvement with your health care.
Public Health and Safety: We may disclose your PHI for public health
and safety purposes to a recognized federal, state or local authority
permitted by law to obtain such information. We may also disclose your
PHI, when necessary, to prevent a serious threat to your health and
safety or the health and safety of the public or another person.
Health Oversight Activities: We may disclose your PHI to a
governmental agency responsible for health care oversight for authorized
activities such as inspections, audits, investigations and legal
actions.
Judicial and Administrative Proceedings: We may disclose your PHI
in the course of a judicial or administrative proceeding in response to
a legal order or other lawful process. If you are involved in a lawsuit,
we may also disclose your PHI in response to a subpoena, discovery
request or other lawful process by someone else involved in the dispute,
but only if efforts have been made to notify you of the request or to
obtain an order protecting the information requested.
Law Enforcement: We may disclose your PHI to law enforcement
officials in connection with law enforcement activities as required or
permitted by law or in compliance with a court order, a court ordered
warrant, subpoena or summons, a grand jury subpoena, an administrative
subpoena or similar process authorized under law.
Decedents: We may disclose your PHI to a coroner, medical
examiner or other official as authorized by law.
Organ and Tissue Donation: We may disclose your PHI to entities
that facilitate organ, eye or tissue donation, banking and
transplantation.
Workers’ Compensation: We may disclose your PHI, to the extent
necessary, in order to comply with state laws relating to workers’
compensation or other similar government programs.
Other Specialized Government Functions: We may disclose your PHI
when federal regulations require such disclosure for purposes of
national security to specialized divisions of the government such as the
military or state department.
Abuse, Neglect or Domestic Violence: We may disclose your PHI to
an appropriate governmental entity authorized to receive reports
regarding suspected abuse, neglect or domestic violence when we
reasonably believe that you are or have been the victim of abuse,
neglect or domestic violence.
Inmates: If you are an inmate in a correctional institution or
under the custody of a law enforcement official we may disclose PHI to
the correctional institution or law enforcement official if such
disclosure is necessary for the provision of health care, to protect
your health and safety or the health and safety of others, or for the
safety and security of the correctional institution or law enforcement
official.
As Required by Law: We may use or disclose your PHI when required
to do so by law.
Other Uses and Disclosures of PHI
Other uses and disclosures will be made only with your written
authorization. You may revoke any such written authorization at any time
except to the extent that we have taken action in reliance upon that
authorization. Any revocation of written authorization must be submitted
in writing to the SSDC-League Health Fund, 1501 Broadway, Suite 1701,
New York, NY 10036.
Your Rights Regarding Your PHI
Right to Request Access: You may request access to your PHI which
includes the right to inspect and/or copy your PHI. Any request for
access must be made in writing to the SSDC-League Health Fund, 1501
Broadway, Suite 1701, New York, NY 10036. If you request a copy of your
PHI, we may charge a reasonable fee for the copying and disbursement
costs (if applicable) associated with your request.
Right to Request Restriction: You have the right to request that
the Fund restrict uses or disclosures of your PHI to carry out
treatment, payment or health care operations and disclosures to certain
individuals (generally, relatives or other representatives) of PHI
directly relevant to such person's involvement in your health care or
payment related to your health care, or in connection with notifying
such individuals of your location, general condition, or death. All such
requests must be submitted in writing to the SSDC-League Health Fund,
1501 Broadway, Suite 1701, New York, NY 10036. We will consider all
requests but are not required to agree to any such requested
restrictions on the use and disclosure of your PHI.
Right to Receive Confidential Communication: You have the right
to request that we communicate with you regarding PHI in a specific
manner or at a specific location. Any such requests must be submitted in
writing to the SSDC-League Health Fund, 1501 Broadway, Suite 1701, New
York, NY 10036. We will consider all reasonable requests, but are not
required to accommodate your requests unless you advise us, in writing,
that communication with you using the Fund's usual procedures could
endanger you.
Right to Amend PHI: If you believe that any PHI maintained by the
Fund is incomplete or otherwise inaccurate, you may request that it be
amended. Any request for amendment must be submitted in writing to the
SSDC-League Health Fund, 1501 Broadway, Suite 1701, New York, NY 10036.
This request must contain a reason to support your request for the
proposed amendment. Generally, we will comply with your request unless
the PHI was not created by the Fund, the PHI is not part of the records
maintained by the Fund, the PHI is not subject to your right to inspect
and copy, or the Fund determines that the PHI is accurate and complete.
Right to Accounting of Disclosures: You may obtain an accounting
of certain disclosures of your PHI by the Fund for certain periods of
time prior to the date of your request. We are only required to provide
an accounting of such disclosures for periods subsequent to April 14,
2004, and in no case are we required to provide an accounting for a
period that extends beyond the six (6) year period prior to the date on
which the accounting is requested. Any request for an accounting must be
submitted in writing to the SSDC-League Health Fund, 1501 Broadway,
Suite 1701, New York, NY 10036.
Right to Receive a Paper Copy of this Notice: Upon request, you
may obtain a paper copy of this Notice. This request must be made in
writing to the SSDC-League Health Fund, 1501 Broadway, Suite 1701, New
York, NY 10036.
Further Information/Complaints
If you desire further information regarding your privacy rights, are
concerned that the Fund has violated your privacy rights or are in any
other way concerned regarding the Fund’s use and disclosure of your PHI,
you may contact our Privacy Officer in writing at the SSDC-League Health
Fund, 1501 Broadway, Suite 1701, New York, NY 10036 or by calling
800-317-9373 or 212-869-8129 and asking for the Privacy Officer. More
specifically, if you believe that your privacy rights have been
violated, you may file a complaint with the Fund by writing to the
attention of the Privacy Officer at that address. You may also file a
written complaint with the Office of Civil Rights, United States
Department of Health and Human Services at 26 Federal Plaza, Suite 3313,
New York, New York 10278; (212) 264-3313; (212) 264-2355 (TDD); (212)
264-3039 (FAX)). You will not be retaliated against in any way for
filing a complaint.
Effective Date and Duration of Notice
Effective Date: April 14, 2004
Right to Change Terms of Notice: The SSDC-League Health Fund
reserves the right to change the terms of this Notice at any time. In
the event that we elect to make any subsequent changes to this Notice,
the revised Notice will be effective for all PHI that the Fund maintains
upon the issuance of the new Notice (including PHI created or received
prior to issuing the revised Notice). Within 60 days of any changes, we
will distribute or post a new Notice in the same or similar manner as
this Notice was distributed or posted. |
|
