NOTICE OF PRIVACY PRACTICES
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 WINhealth Partners Health Plan (the “Plan”) is referred to as “we,” “us,” and “our” in this Notice. Persons insured as participants in the Plan are referred to as “you” and “your” in this Notice.
The Plan is required by law to maintain the privacy of protected health information (PHI). PHI is information that is created or received by the Plan that relates to the past, present or future physical or mental health or condition of a Plan member; the provision of health care to a Plan member; or the past, present or future payment for the provision of health care to a Plan member; and that identifies the Plan member or for which there is a reasonable basis to believe the information can be used to identify the Plan member. This Notice includes information about our legal duties and privacy practices with respect to your PHI. We are required to abide by the terms of this Notice, but we may need to revise our privacy practices from time to time. Thus, we reserve the right to change the terms of the Notice and make the new provisions effective for all PHI that we maintain. We will provide a revised Notice to you within 60 days of any material change.
Permitted Uses and Disclosures of Your Protected Health Information
We may use and/or disclose your PHI for the following purposes:
- Treatment – We may discuss your PHI with heath care providers in order to facilitate medical treatment. For example, Our Medical Management department may discuss your PHI with your doctor in order to authorize coverage for medical services requested by your doctor.
- Payment – We may use and disclose your PHI in order to pay for medical services or equipment you receive that are covered under your benefit plan. In addition, we may disclose your PHI in order to coordinate benefits with other insurance companies. For example, if you receive medical treatment following a motor vehicle accident, we may disclose your PHI to your automobile insurance company in order to coordinate benefits for medical treatment paid under your car insurance policy with those provided under your health benefit plan.
- Health Care Operations – We may use and disclose your PHI in order to operate our business and ensure that you receive quality care. For example, we may disclose your PHI to contracted health care providers tasked with evaluating the quality of treatment and services delivered by participating providers.
- Care Management – We may also use your PHI to identify and contact you about treatment alternatives or other health-related benefits and services that may be of interest to you. For example, if you suffer from a chronic disease such as asthma or diabetes, we may contact you to discuss your participation in our Disease Management program, which assists members in managing treatment of such illnesses. We may also send you newsletters that contain general health information.
- Plan Sponsor – We may disclose your PHI to the Plan Sponsor for use in administering the Plan.
- Health Oversight Activities – We may disclose your PHI to health oversight agencies for oversight activities authorized by law, including audits, investigations, inspections, and licensure or disciplinary actions related to health care programs and entities.
- Disclosure Required by Law – We may use or disclose your PHI when required by law.
- Public Health – We may disclose your PHI to public health authorities tasked with collecting information about public health and monitoring the quality and safety of FDA-regulated products and activities. We may also disclose your PHI to the extent authorized by law in order to notify other persons of potential exposure to a communicable disease and/or risk of contracting or spreading such a disease.
- Workers’ Compensation – We may disclose your PHI as required by workers’ compensation laws or other programs that provide benefits for work-related injuries or illnesses.
- Abuse or Neglect – We may disclose your PHI to the appropriate governmental authorities if we reasonably believe that you have been a victim of abuse, neglect, or domestic violence.
- Legal Proceedings – We may disclose your PHI in response to a court order, subpoena, discovery request or other lawful process related to a judicial or administrative proceeding.
- Business Associates – We may disclose your PHI to third parties we contract with to provide various services. For example, we may disclose your PHI to a third-party consultant hired to review and evaluate the quality of care you received from a Plan provider. These third parties (“business associates”) are also required to maintain the privacy of your PHI.
- Law Enforcement – We may disclose your PHI to law enforcement officials in order to aid in the investigation of a crime.
- Imminent threat to health or safety – We may disclose your PHI as necessary to avoid an imminent threat to your health and safety or that of the public.
- Other – We may disclose PHI of deceased members to coroners or funeral directors. In addition, we may disclose PHI to organ donation and transplant associations to facilitate organ transplants.
Uses and Disclosures of Your Protected Health Information that Require Your Authorization
We must obtain your written permission (“Authorization”) to use or disclose your PHI to any person and for any purpose not referenced above. You have the right to revoke an Authorization at any time, except in cases in which we have already acted based on your permission.
Your Rights with Respect to Your Protected Health Information
- You and/or your personal representative are entitled to see and get a copy of your protected health information held by the Plan.
- You have the right to request restrictions on certain uses and disclosures of your PHI. However, we are not required to agree to requested restrictions.
- You may request that we communicate with you in a different manner or at a different place. For example, you may request that we send correspondence to a post office box instead of your home address.
- You have the right to amend your PHI; however, we may deny a request to amend PHI if it was not created by us or we believe the PHI is accurate and complete. If your amendment request is denied, you may submit a statement of your disagreement to be included with subsequent disclosures of your PHI.
- You may request a list of disclosures we have made of your PHI. Your request may be for disclosures made up to 6 years prior to the date of your request. The list will include the date of each disclosure, the name of the person or entity to whom we made the disclosure, a description of the PHI disclosed, and the reason for such disclosure. The list will not include disclosures made for treatment, payment, or health care operations; disclosures authorized by you or your personal representative; or disclosures required by law.
- You may receive a paper copy of this notice upon request.
If you believe your privacy rights have been violated, you may file a complaint with the Plan and/or with the Secretary of the Department of Health and Human Services. There will be no retaliation of any kind against any person making a complaint. Complaints may be made in writing or electronically to the addresses below:
Attn: Compliance Officer
1200 East 20th Street
Cheyenne, WY 82001
Phone: (307) 773-1300
Toll Free: (800) 868-7670
Fax: (307) 638-7701
Region VIII - Office for Civil Rights
U.S. Department of Health and Human Services
999 18th Street, Suite 417
Denver, CO 80202
Phone: (303) 844-2024
Fax: (303) 844-2025
TDD: (303) 844-3439
WINhealth values your privacy. Information collected is confidential and used strictly for communication purposes regarding your request.