Example. Your company contracts with us to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge. Specific information is not released to employers unless the proper agreements are in place as permitted by law or you have authorized the release. Business associates • We may disclose your health information to our business associates to provide you with products or services on our behalf (such as claims administration or pharmacy benefits management). Business associates are required by law and contract to protect your confidentiality and limit the use of your information. How else can we use or share your health information? We are allowed or required to share your information in other ways — usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. Help with public health and safety issues We can share health information about you for certain situations such as: • Preventing disease, injury, or disability • Reporting suspected abuse, neglect, or domestic violence • Preventing or reducing a serious threat to anyone’s health or safety Do research • We can use or share your information for health research, subject to certain criteria. Comply with the law • We will share information about you if state or federal laws require it, including with the United States Department of Health and Human Services (HHS) if it wants to see that we’re complying with federal privacy laws. Example: responding to a request from the US HHS, the New York State Department of Financial Services (DFS), the New York State Department of Health (DOH), or other appropriate regulatory authority. Respond to organ and tissue donation requests and work with a medical examiner or funeral director • We can share health information about you with organ procurement organizations. • We can share health information with a coroner, medical examiner, or funeral director when an individual dies. Address workers’ compensation, law enforcement, and other government requests We can use or share health information about you: • For workers’ compensation claims • For law enforcement purposes or with a law enforcement official • With health oversight agencies for activities authorized by law • For special government functions such as military, national security, and presidential protective services Respond to lawsuits and legal actions • We can share health information about you in response to a court or administrative order, or in response to a subpoena. Our Responsibilities • We are required by law to maintain the privacy and security of your PHI, and other nonpublic, personal information. • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. • We must follow the duties and privacy practices described in this notice and give you a copy of it. • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. • We establish and enforce security and privacy policies and procedures that protect oral, written, and electronic information. • Annual security and privacy awareness training is completed by the entire workforce population. • We apply physical and electronic safeguards to protect and prevent unauthorized access to your information. • We limit access to PHI as appropriate for workforce members to complete their job. • We provide prospective, existing, and former members the same protection and respect of their information. Changes to the Terms of this Notice Questions Please use the contact information provided if you want more information about our privacy practices, have questions or concerns, or would like to file a complaint. Requests sent to persons, offices or addresses other than the one indicated might result in a delayed response. BlueCross BlueShield of Western New York 0-000-000-0000 (TTY 711) 8 a.m. – 7 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Child Health Plus and Medicaid Managed Care 0-000-000-0000 (TTY 711) 8:30 a.m. – 6 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Medicare Advantage, Medigap, Part D Prescription Drug Plan 0-000-000-0000 (TTY 711) October 1 through March 31:
Appears in 17 contracts
Samples: www.bcbswny.com, Preferred Provider Organization Insurance Contract, Preferred Provider Organization Insurance Contract
Example. Your company contracts with us to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge. Specific information is not released to employers unless the proper agreements are in place as permitted by law or you have authorized the release. Business associates • We may disclose your health information to our business associates to provide you with products or services on our behalf (such as claims administration or pharmacy benefits management). Business associates are required by law and contract to protect your confidentiality and limit the use of your information. How else can we use or share your health information? We are allowed or required to share your information in other ways — usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. Help with public health and safety issues We can share health information about you for certain situations such as: • Preventing disease, injury, or disability • Reporting suspected abuse, neglect, or domestic violence • Preventing or reducing a serious threat to anyone’s health or safety Do research • We can use or share your information for health research, subject to certain criteria. Comply with the law • We will share information about you if state or federal laws require it, including with the United States Department of Health and Human Services (HHS) if it wants to see that we’re complying with federal privacy laws. Example: responding to a request from the US HHS, the New York State Department of Financial Services (DFS), the New York State Department of Health (DOH), or other appropriate regulatory authority. Respond to organ and tissue donation requests and work with a medical examiner or funeral director • We can share health information about you with organ procurement organizations. • We can share health information with a coroner, medical examiner, or funeral director when an individual dies. Address workers’ compensation, law enforcement, and other government requests We can use or share health information about you: • For workers’ compensation claims • For law enforcement purposes or with a law enforcement official • With health oversight agencies for activities authorized by law • For special government functions such as military, national security, and presidential protective services Respond to lawsuits and legal actions • We can share health information about you in response to a court or administrative order, or in response to a subpoena. Our Responsibilities • We are required by law to maintain the privacy and security of your PHI, and other nonpublic, personal information. • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. • We must follow the duties and privacy practices described in this notice and give you a copy of it. • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. • We establish and enforce security and privacy policies and procedures that protect oral, written, and electronic information. • Annual security and privacy awareness training is completed by the entire workforce population. • We apply physical and electronic safeguards to protect and prevent unauthorized access to your information. • We limit access to PHI as appropriate for workforce members to complete their job. • We provide prospective, existing, and former members the same protection and respect of their information. Changes to the Terms of this Notice We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, on our website, and we will mail a copy to you. Questions Please use the contact information provided if you want more information about our privacy practices, have questions or concerns, or would like to file a complaint. Requests sent to persons, offices or addresses other than the one indicated might result in a delayed response. BlueCross BlueShield of Western Northeastern New York 0-000-000-0000 (TTY 711) 8 a.m. – 7 p.m., Monday – Friday PO Box 8015013, BuffaloAlbany, NY 1424012212-0080 Child Health Plus and Medicaid Managed Care 0-000-000-0000 (TTY 711) 8:30 a.m. – 6 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 5013 Medicare Advantage, Medigap, Part D Prescription Drug Plan 0-000-000-0000 (TTY 711) October 1 through March 31:
Appears in 14 contracts
Samples: Preferred Provider Organization Insurance Contract, Preferred Provider Organization Insurance Contract, Preferred Provider Organization Insurance Contract
Example. Your company contracts with us We use health information about you to provide a health plan, manage your treatment and we provide your company with certain statistics to explain the premiums we chargeservices. Specific information is not released to employers unless the proper agreements are in place as permitted by law or you have authorized the release. Business associates • We may disclose use health information to train or teach doctors or other healthcare workers and students. • We use health information to monitor the quality of care and to make improvements where needed. • We use health information to meet standards set by regulatory agencies, such as The Joint Commission, the Massachusetts Department of Public Health, Medicare or Medicaid. Bill for your services We can use and share your health information to our business associates bill and get payment from health plans or other entities. Example: We give information about you to provide you with products or services on our behalf (such as claims administration or pharmacy benefits management). Business associates are required by law and contract to protect your confidentiality and limit the use of health insurance plan so it will pay for your informationservices. How else can we use or share your health information? We are allowed or required to share your information in other ways — – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information, see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxx.xxxx. Help with public health and safety issues We can share health information about you for certain situations such as: • Preventing disease, injury, or disability disease • Helping with product recalls • Reporting adverse reactions to medications • Reporting suspected abuse, neglect, or domestic violence • Preventing or reducing a serious threat to anyone’s health or safety • Responding to certain permitted requests from law enforcement, including for example, to identify or locate a missing person, suspect or fugitive. Do research • We can use or share your information for health research, subject to certain criteria. Comply with the law • We will share information about you if state or federal laws require it, including with the United States Department of Health and Human Services (HHS) if it wants to see that we’re complying with federal privacy laws. Example: responding to a request from the US HHS, the New York State Department of Financial Services (DFS), the New York State Department of Health (DOH), or other appropriate regulatory authoritylaw. Respond to organ and tissue donation requests and work with a medical examiner or funeral director • We can share health information about you with organ procurement organizations. • Work with a medical examiner or funeral director We can share health information with a coroner, medical examiner, or funeral director when an individual dies. Address workers’ compensation, law enforcement, and other government requests We can use or share health information about you: • For workers’ compensation claims • For law enforcement purposes or with a law enforcement official • With health oversight agencies for activities authorized by law bylaw • For special government functions such as military, national security, and presidential protective services Respond to lawsuits and legal actions • We can share health information about you in response to a court or administrative order, or in response to a subpoena. Our Responsibilities • We are required by law to maintain the privacy and security of your PHI, and other nonpublic, personal protected health information. • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. • We must follow the duties and privacy practices described in this notice and give you a copy of it. • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. • We establish and enforce security and privacy policies and procedures that protect oralFor more information, written, and electronic information. • Annual security and privacy awareness training is completed by the entire workforce population. • We apply physical and electronic safeguards to protect and prevent unauthorized access to your information. • We limit access to PHI as appropriate for workforce members to complete their job. • We provide prospective, existing, and former members the same protection and respect of their information. see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxxxxx.xxxx Changes to the Terms of this Notice Questions Please use We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site. Other Instructions for Notice • This notice is effective as of September 23, 2013. • You may contact information provided if you want more information about our privacy practices, have questions or concerns, or would like to file a complaint. Requests sent to persons, offices or addresses other than the one indicated might result in a delayed response. BlueCross BlueShield of Western New York 0-Privacy Officer by calling (000-) 000-0000 (TTY 711) 8 a.m. – 7 p.m.or writing to Privacy Office, Monday – Friday PO Box 80Cambridge Health Alliance, Buffalo0000 Xxxxxxxxx Xxxxxx, NY 14240Xxxxxxxxx XX 00000. To receive a copy of this notice in your language, please ask the front desk at your provider’s office or contact our Privacy Officer as noted above. Para receber uma cópia deste aviso em seu idioma, por favor, solicite na recepção do escritório do seu provedor ou entre em contato comonos so Dire torde Privacidade conforme mencionado acima. Pou resevwa yon kopi avi sa a xxx xxxx ou, tanpri mande resepsyonis nan klinik founisè w la oswa kontakte Ofisyè Konfidansyalite nou an xxx xx note anwo a. Para recibir una copia de este aviso en su idioma, solicítelo en la recepción de su consultorio médico o comuníquese con nuestro Oficial de Privacidad como se indicó anteriormente. General Provisions Changes to Agreement: Changes to this agreement may be made if they are approved by both the US Department of Health & Human Services, Centers for Medicare & Medicaid Services and the Commonwealth of Massachusetts, MassHealth. We will give you at least 30-0080 Child Health Plus and Medicaid Managed Care 0-000-000-0000 (TTY 711) 8:30 a.m. – 6 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Medicare Advantage, Medigap, Part D Prescription Drug Plan 0-000-000-0000 (TTY 711) October 1 through March 31:days written notice of any change.
Appears in 3 contracts
Samples: Enrollment Agreement, Enrollment Agreement, www.challiance.org
Example. Your company contracts with us We give information about you to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge. Specific information is not released to employers unless the proper agreements are in place as permitted by law or you have authorized the release. Business associates • We may disclose your health information to our business associates to provide you with products or services on our behalf (such as claims administration or pharmacy benefits management). Business associates are required by law and contract to protect insurance plan so it will pay for your confidentiality and limit the use of your informationservices. How else can we use or share your health information? We are allowed or required to share your information in other ways — – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxx.xxxx. Help with public health and safety issues We can share health information about you for certain situations such as: • Preventing disease, injury, or disability disease • Helping with product recalls • Reporting adverse reactions to medications • Reporting suspected abuse, neglect, or domestic violence • Preventing or reducing a serious threat to anyone’s health or safety Do research • We can use or share your information for health research, subject to certain criteria. Comply with the law • We will share information about you if state or federal laws require it, including with the United States Department of Health and Human Services (HHS) if it wants to see that we’re complying with federal privacy laws. Example: responding to a request from the US HHS, the New York State Department of Financial Services (DFS), the New York State Department of Health (DOH), or other appropriate regulatory authoritylaw. Respond to organ and tissue donation requests and work with a medical examiner or funeral director • We can share health information about you with organ procurement organizations. • Work with a medical examiner or funeral director We can share health information with a coroner, medical examiner, or funeral director when an individual dies. Address workers’ compensation, law enforcement, and other government requests We can use or share health information about you: • For workers’ compensation claims • For law enforcement purposes or with a law enforcement official • With health oversight agencies for activities authorized by law • For special government functions such as military, national security, and presidential protective services Respond to lawsuits and legal actions • We can share health information about you in response to a court or administrative order, or in response to a subpoena. Our Responsibilities • We are required by law to maintain the privacy and security of your PHI, and other nonpublic, personal protected health information. • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. • We must follow the duties and privacy practices described in this notice Notice and give you a copy of it. • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. • We establish and enforce security and privacy policies and procedures that protect oral, written, and electronic information. • Annual security and privacy awareness training is completed by the entire workforce population. • We apply physical and electronic safeguards to protect and prevent unauthorized access to your information. • We limit access to PHI as appropriate for workforce members to complete their job. • We provide prospective, existing, and former members the same protection and respect of their information. Changes to the Terms of this Notice Questions Please use the contact information provided if you want For more information about our privacy practices, have questions see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxxxxx.xxxx. ELECTRONIC COMMUNICATIONS AGREEMENT FOR PERSONAL HEALTH INFORMATION Placer Private Physicians (“Medical Practice”) and (“Patient”) herein enter into this Electronic Communications Agreement for Personal Health Information (“PHI Agreement”) regarding the use of email or concerns, or would like to file a complaint. Requests sent to persons, offices or addresses other than the one indicated might result in a delayed response. BlueCross BlueShield of Western New York 0-000-000-0000 (TTY 711) 8 a.m. – 7 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Child Health Plus and Medicaid Managed Care 0-000-000-0000 (TTY 711) 8:30 a.m. – 6 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Medicare Advantage, Medigap, Part D Prescription Drug Plan 0-000-000-0000 (TTY 711) October 1 through March 31electronic communications/transmissions:
Appears in 3 contracts
Samples: Physicians Services Agreement, Physicians Services Agreement, Private Physicians Services Agreement
Example. Your company contracts with us We give information about you to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge. Specific information is not released to employers unless the proper agreements are in place as permitted by law or you have authorized the release. Business associates • We may disclose your health information to our business associates to provide you with products or services insurance plan so it will pay for your services. continued on our behalf (such as claims administration or pharmacy benefits management). Business associates are required by law and contract to protect your confidentiality and limit the use of your information. next page How else can we use or share your health information? We are allowed or required to share your information in other ways — – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxx.xxxx. Help with public health and safety issues U We can share health information about you for certain situations such as: • U Preventing disease, injury, or disability • disease U Helping with product recalls U Reporting adverse reactions to medications U Reporting suspected abuse, neglect, or domestic violence • U Preventing or reducing a serious threat to anyone’s health or safety Do research • U We can use or share your information for health research, subject to certain criteria. Comply with the law • U We will share information about you if state or federal laws require it, including with the United States Department of Health and Human Services (HHS) if it wants to see that we’re complying with federal privacy laws. Example: responding to a request from the US HHS, the New York State Department of Financial Services (DFS), the New York State Department of Health (DOH), or other appropriate regulatory authoritylaw. Respond to organ and tissue donation requests and work with a medical examiner or funeral director • U We can share health information about you with organ procurement organizations. • Work with a medical examiner or funeral director U We can share health information with a coroner, medical examiner, or funeral director when an individual dies. Address workers’ compensation, law enforcement, and other government requests U We can use or share health information about you: • U For workers’ compensation claims • U For law enforcement purposes or with a law enforcement official • official U With health oversight agencies for activities authorized by law • U For special government functions such as military, national security, and presidential protective services Respond to lawsuits and legal actions • U We can share health information about you in response to a court or administrative order, or in response to a subpoena. MANNA participates with one or more secure health information organization networks (HIOs), which makes it possible for MANNA to share your Health Information electronically through a secure connected network. MANNA may share or disclose your Health Information to secure HIOs, including HIOs contracted with the Commonwealth of Pennsylvania, and HIOs in other states. Other health care providers, including physicians, hospitals and other health care facilities, that are also connected to the same HIO network as MANNA can access your Health Information for treatment, payment and other authorized purposes, to the extent permitted by law. You have the right to opt out or decline to participate in having MANNA share your Health Information through networked HIOs. If you choose to opt out of data-sharing, through a verbal or written requexx, XXXXX will no longer share your Health Information through an HIO network. Our Responsibilities • U We are required by law to maintain the privacy and security of your PHI, and other nonpublic, personal protected health information. • U We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. • U We must follow the duties and privacy practices described in this notice and give you a copy of it. • U We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. • We establish and enforce security and privacy policies and procedures that protect oral, written, and electronic information. • Annual security and privacy awareness training is completed by the entire workforce population. • We apply physical and electronic safeguards to protect and prevent unauthorized access to your information. • We limit access to PHI as appropriate for workforce members to complete their job. • We provide prospective, existing, and former members the same protection and respect of their informationFor more information see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxxxxx.xxxx. Changes to the Terms of This Notice We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site. Effective January 1, 2019 This Notice Questions Please use of Privacy Practices applies to the contact information provided if you want more information about our privacy practicesfollowing organizations. MANNA 000 Xxxxx 00xx Xxxxxx, have questions or concernsXxxxxxxxxxxx, or would like to file a complaint. Requests sent to persons, offices or addresses other than the one indicated might result in a delayed response. BlueCross BlueShield of Western New York 0-XX 00000 Tel: 000-000-0000 (TTY 711) 8 a.m. – 7 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Child Health Plus and Medicaid Managed Care 0-000-000-0000 (TTY 711) 8:30 a.m. – 6 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Medicare Advantage, Medigap, Part D Prescription Drug Plan 0-000-000-0000 (TTY 711) October 1 through March 31:x0 xxx.xxxxxxx.xxx
Appears in 2 contracts
Samples: Client Agreement and Release of Liability, Client Agreement and Release of Liability
Example. Your company contracts with us We give information about you to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge. Specific information is not released to employers unless the proper agreements are in place as permitted by law or you have authorized the release. Business associates • We may disclose your health information to our business associates to provide you with products or services on our behalf (such as claims administration or pharmacy benefits management). Business associates are required by law and contract to protect insurance plan so it will pay for your confidentiality and limit the use of your informationservices. How else can we use or share your health information? We are allowed or required to share your information in other ways — – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxx.xxxx. Help with public health and safety issues • We can share health information about you for certain situations such as: • Preventing disease, injury, or disability disease • Helping with product recalls • Reporting adverse reactions to medications • Reporting suspected abuse, neglect, or domestic violence • Preventing or reducing a serious threat to anyone’s health or safety Do research • We can use or share your information for health research, subject to certain criteria. Comply with the law • We will share information about you if state or federal laws require it, including with the United States Department of Health and Human Services (HHS) if it wants to see that we’re complying with federal privacy laws. Example: responding to a request from the US HHS, the New York State Department of Financial Services (DFS), the New York State Department of Health (DOH), or other appropriate regulatory authoritylaw. Respond to organ and tissue donation requests and work with a medical examiner or funeral director • We can share health information about you with organ procurement organizations. Work with a medical examiner or funeral director • We can share health information with a coroner, medical examiner, or funeral director when an individual dies. Address workers’ compensation, law enforcement, and other government requests • We can use or share health information about you: • For workers’ compensation claims • For law enforcement purposes or with a law enforcement official • With health oversight agencies for activities authorized by law • For special government functions such as military, national security, and presidential protective services Respond to lawsuits and legal actions • We can share health information about you in response to a court or administrative order, or in response to a subpoena. Our Responsibilities • We are required by law to maintain the privacy and security of your PHI, and other nonpublic, personal protected health information. • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. • We must follow the duties and privacy practices described in this notice and give you a copy of it. • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. • We establish and enforce security and privacy policies and procedures that protect oral, written, and electronic information. • Annual security and privacy awareness training is completed by the entire workforce population. • We apply physical and electronic safeguards to protect and prevent unauthorized access to your information. • We limit access to PHI as appropriate for workforce members to complete their job. • We provide prospective, existing, and former members the same protection and respect of their informationFor more information see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxxxxx.xxxx. Changes to the Terms of This Notice We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site. Our Responsibilities This Notice Questions Please use of Privacy Practices applies to the contact information provided if you want more information about our privacy practices, have questions or concerns, or would like to file a complaint. Requests sent to persons, offices or addresses other than the one indicated might result in a delayed response. BlueCross BlueShield of Western New York 0-000-000-0000 (TTY 711) 8 a.m. – 7 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Child Health Plus and Medicaid Managed Care 0-000-000-0000 (TTY 711) 8:30 a.m. – 6 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Medicare Advantage, Medigap, Part D Prescription Drug Plan 0-000-000-0000 (TTY 711) October 1 through March 31:following organizations.
Appears in 1 contract
Samples: Policy Agreement
Example. Your company contracts with us We give information about you to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge. Specific information is not released to employers unless the proper agreements are in place as permitted by law or you have authorized the release. Business associates • We may disclose your health information to our business associates to provide you with products or services on our behalf (such as claims administration or pharmacy benefits management). Business associates are required by law and contract to protect insurance plan so it will pay for your confidentiality and limit the use of your informationservices. How else can we use or share your health information? We are allowed or required to share your information in other ways — – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxx.xxxx. Help with public health and safety issues We can share health information about you for certain situations such as: • Preventing disease, injury, or disability disease • Helping with product recalls • Reporting adverse reactions to medications • Reporting suspected abuse, neglect, or domestic violence • Preventing or reducing a serious threat to anyone’s health or safety Do research • We can use or share your information for health research, subject to certain criteria. Comply with the law • We will share information about you if state or federal laws require it, including with the United States Department of Health and Human Services (HHS) if it wants to see that we’re complying with federal privacy laws. Example: responding to a request from the US HHS, the New York State Department of Financial Services (DFS), the New York State Department of Health (DOH), or other appropriate regulatory authoritylaw. Respond to organ and tissue donation requests and work with a medical examiner or funeral director • We can share health information about you with organ procurement organizations. • Work with a medical examiner or funeral director We can share health information with a coroner, medical examiner, or funeral director when an individual dies. Address workers’ compensation, law enforcement, and other government requests We can use or share health information about you: • For workers’ compensation claims • For law enforcement purposes or with a law enforcement official • With health oversight agencies for activities authorized by law • For special government functions such as military, national security, and presidential protective services Respond to lawsuits and legal actions • We can share health information about you in response to a court or administrative order, or in response to a subpoena. Our Responsibilities • We are required by law to maintain the privacy and security of your PHI, and other nonpublic, personal protected health information. • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. • We must follow the duties and privacy practices described in this notice and give you a copy of it. • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. • We establish and enforce security and privacy policies and procedures that protect oral, written, and electronic information. • Annual security and privacy awareness training is completed by the entire workforce population. • We apply physical and electronic safeguards to protect and prevent unauthorized access to your information. • We limit access to PHI as appropriate for workforce members to complete their job. • We provide prospective, existing, and former members the same protection and respect of their informationFor more information see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxxxxx.xxxx. Changes to the Terms of this Notice Questions Please use We can change the contact terms of this notice, and the changes will apply to all information provided if you want more information we have about you. The new notice will be available upon request, in our privacy practicesoffice, have questions or concerns, or would like to file a complaintand on our web site. Requests sent to persons, offices or addresses other than the one indicated might result in a delayed response. BlueCross BlueShield of Western New York 0-000-000-0000 (TTY 711) 8 a.m. – 7 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Child Health Plus Your rights and Medicaid Managed Care 0-000-000-0000 (TTY 711) 8:30 a.m. – 6 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Medicare Advantage, Medigap, Part D Prescription Drug Plan 0-000-000-0000 (TTY 711) October 1 through March 31:responsibilities under HIPAA are further addressed here: xxxx://xxx.xxx.xxx/hipaa/for-individuals/guidance-materials-for-consumers/index.html
Appears in 1 contract
Example. Your company contracts with us We give information about you to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge. Specific information is not released to employers unless the proper agreements are in place as permitted by law or you have authorized the release. Business associates • We may disclose your health information to our business associates to provide you with products or services on our behalf (such as claims administration or pharmacy benefits management). Business associates are required by law and contract to protect insurance plan so it will pay for your confidentiality and limit the use of your informationservices. How else can we use or share your health information? We are allowed or required to share your information in other ways — – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxx.xxxx. Help with public health and safety issues We can share health information about you for certain situations such as: • Preventing disease, injury, or disability disease • Helping with product recalls • Reporting adverse reactions to medications • Reporting suspected abuse, neglect, or domestic violence • Preventing or reducing a serious threat to anyone’s health or safety Do research • We can use or share your information for health research, subject to certain criteria. Comply with the law • We will share information about you if state or federal laws require it, including with the United States Department of Health and Human Services (HHS) if it wants to see that we’re complying with federal privacy laws. Example: responding to a request from the US HHS, the New York State Department of Financial Services (DFS), the New York State Department of Health (DOH), or other appropriate regulatory authoritylaw. Respond to organ and tissue donation requests and work with a medical examiner or funeral director • We can share health information about you with organ procurement organizations. • Work with a medical examiner or funeral director We can share health information with a coroner, medical examiner, or funeral director when an individual dies. Address workers’ compensation, law enforcement, and other government requests We can use or share health information about you: • For workers’ compensation claims • For law enforcement purposes or with a law enforcement official • With health oversight agencies for activities authorized by law • For special government functions such as military, national security, and presidential protective services Respond to lawsuits and legal actions • We can share health information about you in response to a court or administrative order, or in response to a subpoena. Our Responsibilities • We are required by law to maintain the privacy and security of your PHI, and other nonpublic, personal protected health information. • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. • We must follow the duties and privacy practices described in this notice Notice and give you a copy of it. • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. • We establish and enforce security and privacy policies and procedures that protect oral, written, and electronic information. • Annual security and privacy awareness training is completed by the entire workforce population. • We apply physical and electronic safeguards to protect and prevent unauthorized access to your information. • We limit access to PHI as appropriate for workforce members to complete their job. • We provide prospective, existing, and former members the same protection and respect of their information. Changes to the Terms of this Notice Questions Please use the contact information provided if you want more information about our privacy practices, have questions or concerns, or would like to file a complaint. Requests sent to persons, offices or addresses other than the one indicated might result in a delayed response. BlueCross BlueShield of Western New York 0-000-000-0000 (TTY 711) 8 a.m. – 7 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Child Health Plus and Medicaid Managed Care 0-000-000-0000 (TTY 711) 8:30 a.m. – 6 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Medicare Advantage, Medigap, Part D Prescription Drug Plan 0-000-000-0000 (TTY 711) October 1 through March 31:.
Appears in 1 contract
Example. Your company contracts with us We use health information about you to provide a health plan, manage your treatment and we provide your company with certain statistics to explain the premiums we chargeservices. Specific information is not released to employers unless the proper agreements are in place as permitted by law or you have authorized the release. Business associates • We may disclose can use and share your health information to our business associates bill and get payment from health plans or other entities. Bill for your • services Example: We give information about you to provide you with products or services your health insurance plan so it will pay for your services. continued on our behalf (such as claims administration or pharmacy benefits management). Business associates are required by law and contract to protect your confidentiality and limit the use of your information. next page How else can we use or share your health information? We are allowed or required to share your information in other ways — – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxx.xxxx. Help with public health and safety issues • We can share health information about you for certain situations such as: • Preventing disease, injury, or disability disease • Helping with product recalls • Reporting adverse reactions to medications • Reporting suspected abuse, neglect, or domestic violence • Preventing or reducing a serious threat to anyone’s health or safety Do research • We can use or share your information for health research, subject to certain criteria. Comply with the law • We will share information about you if state or federal laws require it, including with the United States Department of Health and Human Services (HHS) if it wants to see that we’re complying with federal privacy laws. Example: responding to a request from the US HHS, the New York State Department of Financial Services (DFS), the New York State Department of Health (DOH), or other appropriate regulatory authoritylaw. Respond to organ and tissue donation requests and work with a medical examiner or funeral director • We can share health information about you with organ procurement organizations. Work with a medical examiner or funeral director • We can share health information with a coroner, medical examiner, or funeral director when an individual dies. Address workers’ compensation, law enforcement, and other government requests • We can use or share health information about you: • For workers’ compensation claims • For law enforcement purposes or with a law enforcement official • With health oversight agencies for activities authorized by law • For special government functions such as military, national security, and presidential protective services Respond to lawsuits and legal actions • We can share health information about you in response to a court or administrative order, or in response to a subpoena. IMPORTANT NOTES: - We do not create or manage client directories. - In the event our state laws or any other law require greater limits on disclosures of your health information, you will receive a State Law Addendum to our Notice of HIPAA Privacy Practices in paper format. - If you have any questions or concerns about the information in this Notice of HIPAA Privacy Practices, please call our office during business hours using the contact information for our HIPAA Privacy Officer. Our Responsibilities • We are required by law to maintain the privacy and security of your PHI, and other nonpublic, personal protected health information. • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. • We must follow the duties and privacy practices described in this notice and give you a copy of it. • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. • We establish and enforce security and privacy policies and procedures that protect oral, written, and electronic information. • Annual security and privacy awareness training is completed by the entire workforce population. • We apply physical and electronic safeguards to protect and prevent unauthorized access to your information. • We limit access to PHI as appropriate for workforce members to complete their job. • We provide prospective, existing, and former members the same protection and respect of their informationFor more information see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/ noticepp.html. Changes to the Terms of this Notice Questions Please use We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site. EFFECTIVE DATE: DECEMBER 1, 2016 This Notice of Privacy Practices applies to the following organizations. Best at Home All of our clients also receive a paper copy of our Notice of HIPAA Privacy Practices, which has our contact information provided if printed on pages 1 and 5. If you want would like a paper copy of this Notice of HIPAA Privacy Practices, please do not hesitate to ask! For more information about our privacy practices, have or to answer any of your HIPAA questions or concerns, please call our office during business hours using the contact information for our HIPAA Privacy & Security Officer. Name of Individual or would like Name of Personal Representative Date Signature of Individual or Personal Representative Clients Rights and Responsibilities • You have the right to file be informed about and/or participate in the plan of service being provided. • You have the right to be promptly and fully informed of any changes in the service plan. Any change in time of service, availability or staff changes shall be reported to you prior to the time of service. • You have the right to accept or refuse services at any time. • You have the right to be fully informed of the charges for services. • You have the right to be informed of the agency’s name, business telephone number and the business address of the person supervising the services. • You have the right to be informed of the Agencies Complaint Procedures and the right to submit complaints, without fear of discrimination or retaliation and to have the agency conducts a complaintcomplete investigation within a reasonable period of time. Requests sent • You have the right of Confidentiality of Clients records. • You have the right to persons, offices or addresses other than have all property and residence treated with respect. • You have the one indicated might result right to receive a written notice of the address and telephone number of the state licensing authority. (This information has been provided in the Client Service Agreement). • You have the right to obtain a delayed response. BlueCross BlueShield copy of Western New York 0-000-000-0000 (TTY 711) 8 a.m. – 7 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Child Health Plus and Medicaid Managed Care 0-000-000-0000 (TTY 711) 8:30 a.m. – 6 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Medicare Advantage, Medigap, Part D Prescription Drug Plan 0-000-000-0000 (TTY 711) October 1 through March 31:Best at Home recent report of licensure inspection upon written request.
Appears in 1 contract
Samples: Client Service Agreement
Example. Your company contracts with us We give information about you to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge. Specific information is not released to employers unless the proper agreements are in place as permitted by law or you have authorized the release. Business associates • We may disclose your health information to our business associates to provide you with products or services on our behalf (such as claims administration or pharmacy benefits management). Business associates are required by law and contract to protect insurance plan so it will pay for your confidentiality and limit the use of your informationservices. How else can we use or share your health information? We are allowed or required to share your information in other ways — B usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxx.xxxx. Help with public health and safety issues issues. We can share health information about you for certain situations such as: • Preventing disease, injury, or disability disease • Helping with product recalls • Reporting adverse reactions to medications • Reporting suspected abuse, neglect, or domestic violence • Preventing or reducing a serious threat to anyone’s health or safety Do research • We can use or share your information for health research, subject to certain criteria. Comply with the law • We will share information about you if state or federal laws require it, including with the United States Department of Health and Human Services (HHS) if it wants to see that we’re complying with federal privacy laws. Example: responding to a request from the US HHS, the New York State Department of Financial Services (DFS), the New York State Department of Health (DOH), or other appropriate regulatory authoritylaw. Respond to organ and tissue donation requests and work with a medical examiner or funeral director • We can share health information about you with organ procurement organizations. • Work with a medical examiner or funeral director We can share health information with a coroner, medical examiner, or funeral director when an individual dies. Address workers’ compensation, law enforcement, and other government requests We can use or share health information about you: • For workers’ compensation claims • For law enforcement purposes or with a law enforcement official • With health oversight agencies for activities authorized by law • For special government functions such as military, national security, and presidential protective services Respond to lawsuits and legal actions • We can share health information about you in response to a court or administrative order, or in response to a subpoena. Our Responsibilities • We are required by law to maintain the privacy and security of your PHI, and other nonpublic, personal protected health information. • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. • We must follow the duties and privacy practices described in this notice and give you a copy of it. • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. • We establish and enforce security and privacy policies and procedures that protect oral, written, and electronic information. • Annual security and privacy awareness training is completed by the entire workforce population. • We apply physical and electronic safeguards to protect and prevent unauthorized access to your information. • We limit access to PHI as appropriate for workforce members to complete their job. • We provide prospective, existing, and former members the same protection and respect of their information. Changes to the Terms of this Notice Questions Please use the contact information provided if you want For more information about our privacy practices, have questions or concerns, or would like to file a complaint. Requests sent to persons, offices or addresses other than the one indicated might result in a delayed response. BlueCross BlueShield of Western New York 0-000-000-0000 (TTY 711) 8 a.m. – 7 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Child Health Plus and Medicaid Managed Care 0-000-000-0000 (TTY 711) 8:30 a.m. – 6 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Medicare Advantage, Medigap, Part D Prescription Drug Plan 0-000-000-0000 (TTY 711) October 1 through March 31:see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxxxxx.xxxx.
Appears in 1 contract
Samples: Admission Agreement
Example. Your company contracts with us I give information about you to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge. Specific information is not released to employers unless the proper agreements are in place as permitted by law or you have authorized the release. Business associates • We may disclose your health information to our business associates to provide you with products or services on our behalf (such as claims administration or pharmacy benefits management). Business associates are required by law and contract to protect insurance plan so it will pay for your confidentiality and limit the use of your informationservices. How else can we I use or share your health information? We are I am allowed or required to share your information in other ways — – usually in ways that contribute to the public good, such as public health and research. We I have to meet many conditions in the law before we I can share your information for these purposes. For more information, see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxx.xxxx. Help with public health and safety issues We I can share health information about you for certain situations such as: • Preventing disease, injury, or disability disease • Helping with product recalls • Reporting adverse reactions to medications • Reporting suspected abuse, neglect, or domestic violence • Preventing or reducing a serious threat to anyone’s health or safety Do research • We I can use or share your information for health research, subject to certain criteria. Comply with the law • We I will share information about you if state or federal laws require it, including with the United States Department of Health and Human Services (HHS) if it wants to see that we’re I’m complying with federal privacy laws. Example: responding to a request from the US HHS, the New York State Department of Financial Services (DFS), the New York State Department of Health (DOH), or other appropriate regulatory authoritylaw. Respond to organ and tissue donation requests and work with a medical examiner or funeral director • We I can share health information about you with organ procurement organizations. • We Work with a medical examiner or funeral director I can share health information with a coroner, medical examiner, or funeral director when an individual dies. Address workers’ compensation, law enforcement, and other government requests We I can use or share health information about you: • For workers’ compensation claims • For law enforcement purposes or with a law enforcement official • With health oversight agencies for activities authorized by law • For special government functions such as military, national security, and presidential protective services Respond to lawsuits and legal actions • We I can share health information about you in response to a court or administrative order, or in response to a subpoena. Our My Responsibilities • We are I am required by law to maintain the privacy and security of your PHI, and other nonpublic, personal protected health information. • We I will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. • We I must follow the duties and privacy practices described in this notice and give you a copy of it. • We I will not use or share your information other than as described here unless you tell us we me I can in writing. If you tell us we me I can, you may change your mind at any time. Let us me know in writing if you change your mind. • We establish and enforce security and privacy policies and procedures that protect oralFor more information, written, and electronic information. • Annual security and privacy awareness training is completed by the entire workforce population. • We apply physical and electronic safeguards to protect and prevent unauthorized access to your information. • We limit access to PHI as appropriate for workforce members to complete their job. • We provide prospective, existing, and former members the same protection and respect of their informationsee: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxxxxx.xxxx. Changes to the Terms of this Notice Questions Please use I can change the contact terms of this notice, and the changes will apply to all information provided if you want more information I have about our privacy practicesyou. The new notice will be available upon request, have questions or concernsin my office, or would like to file a complaintand on my web site. Requests sent to personsEffective 8/1/16; Xxxxx Xxxx, offices or addresses other than the one indicated might result in a delayed response. BlueCross BlueShield of Western New York 0-LLC; 000-000-0000 (TTY 711) 8 a.m. – 7 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Child Health Plus and Medicaid Managed Care 0-000-000-0000 (TTY 711) 8:30 a.m. – 6 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Medicare Advantage, Medigap, Part D Prescription Drug Plan 0-000-000-0000 (TTY 711) October 1 through March 31:0000; *I never market or sell personal information.
Appears in 1 contract
Samples: Client Consent and Agreement for Psychological Services
Example. Your company Company contracts with us to provide a health plan, and we provide your company Company with certain specific statistics to explain the premiums we charge. Specific information is not released to employers unless the proper agreements are in place as permitted by law or you have authorized the release. Business associates • We may disclose your health information to our business associates to provide you with products or services on our behalf (such as claims administration or pharmacy benefits management). Business associates are required by law and contract to protect your confidentiality and limit the use of your information. How else can we use or share your health information? • We are allowed or required to share your information in other ways — – usually in ways that contribute to the public good, such as public health and research. We have to However, we must meet many conditions in the law before we can share sharing your information for these purposes. • For more information, see xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxx.xxxx. Help with public health and safety issues We can share health information about you for certain situations such as: • Preventing disease, injury, or disability disease • Helping with product recalls • Reporting adverse reactions to medications • Reporting suspected abuse, neglect, or domestic violence • Preventing or reducing a serious threat to anyone’s 's health or safety safety. Do research • We can use or share your information for health research, subject to certain criteria. Comply with the law • We will share information about you if state or federal laws require it, including with the United States Department of Health and Human Services (HHS) if it wants to see that we’re complying we comply with federal privacy lawslaw. Example: responding • We may report information to a request from state agencies that regulate us, such as the US HHS, the New York State Georgia Department of Financial Services (DFS), the New York State Department of Health (DOH), or other appropriate regulatory authorityInsurance. Respond to organ and tissue donation requests and work with a medical examiner or funeral director • We can share health information about you with organ procurement organizations. • We When an individual dies, we can share health information with a coroner, medical examiner, or funeral director when an individual diesdirector. Address workers’ ' compensation, law enforcement, and other government requests requests. We can use or share health information about you: • For workers’ ' compensation claims • For law enforcement purposes or with a law enforcement official • With health oversight agencies for activities authorized by law • For special Special government functions such as include military, national security, and presidential protective services services. Respond to lawsuits and legal actions • We can share health information about you in response to a court or administrative order, order or in response reply to a subpoena. Our Responsibilities Assist in fundraising activities We can use or share health information for purposes of fundraising activities within these guidelines: • The information used or disclosed must be limited to your demographic information and the health care dates. • If we are not preparing the fundraising within our organization, the information can only be disclosed to a business associate or an institutionally related foundation. • Any fundraising materials must include a description of how you can opt-out of future fundraising communications. • Your PHI will not be used for fundraising activities unless you provide authorization for the fundraising activity. • Upon authorization of your use of PHI in a fundraising activity, we will provide instructions on how you may opt-out of future fundraising communications or revoke the authorization relating to these activities. • We will maintain a log of all individuals who have revoked fundraising authorizations or opted out of receiving future communications. • We must make reasonable efforts to ensure that you do not receive further fundraising materials if you have revoked your authorization or exercised your opt-out rights. OUR RESPONSIBILITIES • We are required by law to maintain the privacy and security of your PHI, and other nonpublic, personal protected health information. • We will let promptly inform you know promptly if a breach occurs that may have compromised the your information's privacy or security of your informationsecurity. • We must follow the duties and privacy practices described in this notice and give you a copy of itcopy. • We will not use or share your information other than as described here unless you tell us we can us, in writing, that we may. If you tell us we can, you may change your mind at any timeanytime. Let us know in writing if you change your mind. • We establish and enforce security and privacy policies and procedures Once you authorize us to release your health information, we cannot guarantee that protect oral, written, and electronic the person to whom the information is provided will not disclose the information. • Annual security and privacy awareness training is completed by the entire workforce population. • We apply physical and electronic safeguards to protect and prevent unauthorized access to your For more information. • We limit access to PHI as appropriate for workforce members to complete their job. • We provide prospective, existing, and former members the same protection and respect of their information. Changes to the Terms of this Notice Questions Please use the contact information provided if you want more information about our privacy practices, have questions or concerns, or would like to file a complaint. Requests sent to persons, offices or addresses other than the one indicated might result in a delayed response. BlueCross BlueShield of Western New York 0-000-000-0000 (TTY 711) 8 a.m. – 7 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Child Health Plus and Medicaid Managed Care 0-000-000-0000 (TTY 711) 8:30 a.m. – 6 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Medicare Advantage, Medigap, Part D Prescription Drug Plan 0-000-000-0000 (TTY 711) October 1 through March 31:see xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxxxxx.xxxx.
Appears in 1 contract
Samples: Administrative Services Agreement
Example. Your company contracts with us We give information about you to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge. Specific information is not released to employers unless the proper agreements are in place as permitted by law or you have authorized the release. Business associates • We may disclose your health information to our business associates to provide you with products or services on our behalf (such as claims administration or pharmacy benefits management). Business associates are required by law and contract to protect insurance plan so it will pay for your confidentiality and limit the use of your informationservices. How else can we use or share your health information? We are allowed or required to share your information in other ways — – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxx.xxxx. Help with public health and safety issues We can share health information about you for certain situations such as: • Preventing disease, injury, or disability disease • Helping with product recalls • Reporting adverse reactions to medications • Reporting suspected abuse, neglect, or domestic violence • Preventing or reducing a serious threat to anyone’s health or safety Do research • We can use or share your information for health research, subject to certain criteria. Comply with the law • We will share information about you if state or federal laws require it, including with the United States Department of Health and Human Services (HHS) if it wants to see that we’re complying with federal privacy laws. Example: responding to a request from the US HHS, the New York State Department of Financial Services (DFS), the New York State Department of Health (DOH), or other appropriate regulatory authoritylaw. Respond to organ and tissue donation requests and work with a medical examiner or funeral director • We can share health information about you with organ procurement organizations. • Work with a medical examiner or funeral director We can share health information with a coroner, medical examiner, or funeral director when an individual dies. Address workers’ compensation, law enforcement, and other government requests We can use or share health information about you: • For workers’ compensation claims • For law enforcement purposes or with a law enforcement official • With health oversight agencies for activities authorized by law • For special government functions such as military, national security, and presidential protective services Respond to lawsuits and legal actions • We can share health information about you in response to a court or administrative order, or in response to a subpoena. Our Responsibilities • We are required by law to maintain the privacy and security of your PHI, and other nonpublic, personal protected health information. • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. • We must follow the duties and privacy practices described in this notice and give you a copy of it. • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. • We establish and enforce security and privacy policies and procedures that protect oral, written, and electronic information. • Annual security and privacy awareness training is completed by the entire workforce population. • We apply physical and electronic safeguards to protect and prevent unauthorized access to your information. • We limit access to PHI as appropriate for workforce members to complete their job. • We provide prospective, existing, and former members the same protection and respect of their informationFor more information see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxxxxx.xxxx. Changes to the Terms of this Notice Questions Please use We can change the contact terms of this notice, and the changes will apply to all information provided if we have about you. The new notice will be available upon request, in our office, and on our web site. Complaints Complaints about this Notice of Privacy Practices or how this medical practice handles your health information should be directed to our Privacy Officer: Xxxxx Xxxx, MD 00000 XxxXxxxxx Xxxxxxxxx, #000, Xxxxxx, XX 00000 (000) 000-0000 xxxxx@xxxxxxxxxxxxxxxx.xxx If you want more information about our privacy practices, have questions or concerns, or would like to file are not satisfied with the manner in which this office handles a complaint. Requests sent to persons, offices or addresses other than the one indicated might result in you may submit a delayed response. BlueCross BlueShield formal complaint to: Region IX Office for Civil Rights U.S. Department of Western New York Health & Human Services 00 0xx Xxxxxx, Xxxxx 0-000 Xxx Xxxxxxxxx, XX 00000 (000) 000-0000; (000) 000-0000 (TTY 711TDD) 8 a.m. – 7 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Child Health Plus and Medicaid Managed Care 0-(000-) 000-0000 FAX XXXXxxx@xxx.xxx The complaint form may be found at xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxx/xxxxxxxxxxxx.xxx You will not be penalized in any way for filing a complaint. Acknowledgement of Receipt of Notice of Privacy Policies Our Notice of Privacy Policies provides details on how we may use and/or disclose your personal health information. By signing this form, you are acknowledging receipt of this Notice of Privacy Policies. You are not required to sign this acknowledgement. I acknowledge that I have received a copy of the Notice of Privacy Policies as it pertains to Halcyon Health Direct Primary Care. Printed Name Signature Date For Office Use Only If No Acknowledgement Obtained Halcyon Health Direct Primary Care is unable to obtain written acknowledgement of receipt of our Notice of Privacy Policies from because: (TTY 711Name of Patient) 8:30 a.m. – 6 p.m.¨ Patient refused to sign ¨ Due to an emergency situation where patient is unable to give acknowledgement ¨ We were unable to communicate with the patient ¨ Other Consent for Use/Disclosure of Personal Health Information Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Monday – Friday PO Box 80I have rights to privacy regarding my protected personal health information. I understand that under HIPAA this protected health information may be used for: • Coordinating, Buffaloplanning, NY 14240conducting treatment with healthcare providers directly or indirectly involved with my treatment • Obtaining any potential payment with third party payers • Conducting normal health care operations such as quality assessments/evaluations and physician re-0080 Medicare Advantagecertifications. The Notice of Privacy Policies provides further details of the uses and disclosures of protected health information and my rights under HIPAA. I understand that I have the right to a copy of the Notice of Privacy Policies and that I have been offered a digital or print copy for review prior to signing this consent form. I understand that Halcyon Health Direct Primary Care has the right to change the terms of the Notice of Privacy Policies and I have the right to request the most current copy of this notice. I have the right to revoke consent by giving written notice to our privacy office. However, Medigapany use or disclosure of protected health information occurring prior to the date I revoke this consent is not affected. I give permission for my Protected Health Information (PHI) to be disclosed for purposes of communicating results, Part D Prescription Drug Plan 0-000-000-0000 findings, and care discussions to the family members and others listed below: Name: Relationship: Contact Info: Name: Relationship: Contact Info: Name: Relationship: Contact Info: Name: Relationship: Contact Info: I, , understand that I am giving Halcyon Health Direct Primary Care consent to use and disclose my protected health information as detailed in the Notice of Privacy Policies. Signature Date Relationship to Patient if Signed by Patient’s Representative Authorization for Release of Medical Information Patient Name: Date of Birth: By this written authorization, I permit: Healthcare Provider: Address: Phone: Fax: (TTY 711Entire record for the past 2 years) October 1 through March 31:to release my medical information regarding my: [ ]Medical Information Record [ ]Psychiatric Health Record (Past 5 Years) [ ]Chemical/Alcohol Treatment Record [ ]HIV status [ ]Genetic Information Information is being requested from: Halcyon Health Direct Primary Care 00000 XxxXxxxxx Xxxx #000 Xxxxxx, XX 00000 Phone (949) 4868530, Fax (949) 4868531 I understand that by signing this authorization: ● That the authorization is effective from the date following my signature and shall terminate one year from that date. ● I authorize the use or disclosure of my individually identifiable health information as described above for the purpose listed. ● I have the right to withdraw permission for the release of my information. If I sign this authorization to use or disclose information, I can revoke that authorization at any time. ● The revocation must be made in writing and will not affect information that has already been used or disclosed. ● I have the right to receive a copy of this authorization. ● I am signing this authorization voluntarily. ● I further understand that a person to whom records and information are disclosed pursuant to this authorization may not further use or disclose the medical information unless another authorization is obtained from me or unless such disclosure is specifically required or permitted by law. Signed by Patient: Date: Or Signed by Personal Representative: On Behalf of (Name of
Appears in 1 contract
Example. Your company contracts with us We give information about you to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge. Specific information is not released to employers unless the proper agreements are in place as permitted by law or you have authorized the release. Business associates • We may disclose your health information to our business associates to provide you with products or services on our behalf (such as claims administration or pharmacy benefits management). Business associates are required by law and contract to protect insurance plan so it will pay for your confidentiality and limit the use of your informationservices. How else can we use or share your health information? We are allowed or required to share your information in other ways — – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxx.xxxx. Help with public health and safety issues ● We can share health information about you for certain situations such as: • ○ Preventing disease, injury, or disability • disease ○ Helping with product recalls ○ Reporting adverse reactions to medications ○ Reporting suspected abuse, neglect, or domestic violence • ○ Preventing or reducing a serious threat to anyone’s health or safety Do research • ● We can use or share your information for health research, subject to certain criteria. Comply with the law • ● We will share information about you if state or federal laws require it, including with the United States Department of Health and Human Services (HHS) if it wants to see that we’re complying with federal privacy laws. Example: responding to a request from the US HHS, the New York State Department of Financial Services (DFS), the New York State Department of Health (DOH), or other appropriate regulatory authoritylaw. Respond to organ and tissue donation requests and work with a medical examiner or funeral director • ● We can share health information about you with organ procurement organizations. • Work with a medical examiner or funeral director ● We can share health information with a coroner, medical examiner, or funeral director when an individual dies. Address workers’ compensation, law enforcement, and other government requests ● We can use or share health information about you: • ● For workers’ compensation claims • ● For law enforcement purposes or with a law enforcement official • ● With health oversight agencies for activities authorized by law • ● For special government functions such as military, national security, and presidential protective services Respond to lawsuits and legal actions • ● We can share health information about you in response to a court or administrative order, or in response to a subpoena. Our Responsibilities • ● We are required by law to maintain the privacy and security of your PHI, and other nonpublic, personal protected health information. • ● We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. • ● We must follow the duties and privacy practices described in this notice and give you a copy of it. • ● We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. • We establish and enforce security and privacy policies and procedures that protect oral, written, and electronic information. • Annual security and privacy awareness training is completed by the entire workforce population. • We apply physical and electronic safeguards to protect and prevent unauthorized access to your information. • We limit access to PHI as appropriate for workforce members to complete their job. • We provide prospective, existing, and former members the same protection and respect of their information. Changes to the Terms of this Notice Questions Please use the contact information provided if you want more information about our privacy practices, have questions or concerns, or would like to file a complaint. Requests sent to persons, offices or addresses other than the one indicated might result in a delayed response. BlueCross BlueShield of Western New York 0-000-000-0000 (TTY 711) 8 a.m. – 7 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Child Health Plus and Medicaid Managed Care 0-000-000-0000 (TTY 711) 8:30 a.m. – 6 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Medicare Advantage, Medigap, Part D Prescription Drug Plan 0-000-000-0000 (TTY 711) October 1 through March 31:.
Appears in 1 contract
Samples: static1.squarespace.com
Example. Your company contracts with us We give information about you to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge. Specific information is not released to employers unless the proper agreements are in place as permitted by law or you have authorized the release. Business associates • We may disclose your health information to our business associates to provide you with products or services on our behalf (such as claims administration or pharmacy benefits management). Business associates are required by law and contract to protect insurance plan so it will pay for your confidentiality and limit the use of your informationservices. How else can we use or share your health information? We are allowed or required to share your information in other ways — – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxx.xxxx. Help with public health and safety issues We can share health information about you for certain situations such as: • Preventing disease, injury, or disability disease • Helping with product recalls • Reporting adverse reactions to medications • Reporting suspected abuse, neglect, or domestic violence • Preventing or reducing a serious threat to anyone’s health or safety Do research • research: We can use or share your information for health research, subject to certain criteria. Comply with the law • We will share information about you if state or federal laws require it, including with the United States Department of Health and Human Services (HHS) if it wants to see that we’re complying with federal privacy lawslaw. ExampleInformation will be shared in the following cases: responding ● An indication of child abuse or neglect is occurring or has occurred. ● An indication that abuse or neglect of an incapacitated adult is occurring or occurred. ● If you threaten to harm yourself. ● If you threaten to harm another person. ● If you gravely disabled and unable to care for yourself. ● The disclosure of a request from previously unreported felony crime that was committed. ● To assist relevant authorized personnel (doctors, nurses, etc.) in the US HHS, event of a medical emergency. ● To report the New York State Department misconduct of Financial Services (DFS), the New York State Department of Health (DOH), or other appropriate regulatory authorityprofessionals. Respond to organ and tissue donation requests and work with a medical examiner or funeral director • We can share health information about you with organ procurement organizations. • Work with a medical examiner or funeral director We can share health information with a coroner, medical examiner, or funeral director when an individual dies. Address workers’ compensation, law enforcement, and other government requests We can use or share health information about you: • For workers’ compensation claims • For law enforcement purposes or with a law enforcement official • With health oversight agencies for activities authorized by law • For special government functions such as military, national security, and presidential protective services Respond to lawsuits and legal actions • We can share health information about you in response to a court or administrative order, or in response to a subpoena. Our Responsibilities • We are required by law to maintain the privacy and security of your PHI, and other nonpublic, personal protected health information. • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. • We must follow the duties and privacy practices described in this notice and give you a copy of it. • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. • We establish and enforce security and privacy policies and procedures that protect oral, written, and electronic information. • Annual security and privacy awareness training is completed by the entire workforce population. • We apply physical and electronic safeguards to protect and prevent unauthorized access to your information. • We limit access to PHI as appropriate for workforce members to complete their job. • We provide prospective, existing, and former members the same protection and respect of their information. Changes to the Terms of this Notice Questions Please use the contact information provided if you want more information about our privacy practices, have questions or concerns, or would like to file a complaint. Requests sent to persons, offices or addresses other than the one indicated might result in a delayed response. BlueCross BlueShield of Western New York 0-000-000-0000 (TTY 711) 8 a.m. – 7 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Child Health Plus and Medicaid Managed Care 0-000-000-0000 (TTY 711) 8:30 a.m. – 6 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Medicare Advantage, Medigap, Part D Prescription Drug Plan 0-000-000-0000 (TTY 711) October 1 through March 31:.
Appears in 1 contract
Samples: www.joycounselingservices.com
Example. Your company Company contracts with us to provide a health plan, and we provide your company Company with certain specific statistics to explain the premiums we charge. Specific information is not released to employers unless the proper agreements are in place as permitted by law or you have authorized the release. Business associates • We may disclose your health information to our business associates to provide you with products or services on our behalf (such as claims administration or pharmacy benefits management). Business associates are required by law and contract to protect your confidentiality and limit the use of your information. How else can we use or share your health information? • We are allowed or required to share your information in other ways — – usually in ways that contribute to the public good, such as public health and research. We have to However, we must meet many conditions in the law before we can share sharing your information for these purposes. • For more information, see xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxx.xxxx. Help with public health and safety issues We can share health information about you for certain situations such as: • Preventing disease, injury, or disability disease • Helping with product recalls • Reporting adverse reactions to medications • Reporting suspected abuse, neglect, or domestic violence • Preventing or reducing a serious threat to anyone’s 's health or safety safety. Do research • We can use or share your information for health research, subject to certain criteria. Comply with the law • We will share information about you if state or federal laws require it, including with the United States Department of Health and Human Services (HHS) if it wants to see that we’re complying we comply with federal privacy lawslaw. Example: responding • We may report information to a request from state agencies that regulate us, such as the US HHS, the New York State Georgia Department of Financial Services (DFS), the New York State Department of Health (DOH), or other appropriate regulatory authorityInsurance. Respond to organ and tissue donation requests and work with a medical examiner or funeral director • We can share health information about you with organ procurement organizations. • We When an individual dies, we can share health information with a coroner, medical examiner, or funeral director when an individual diesdirector. Address workers’ ' compensation, law enforcement, and other government requests requests. We can use or share health information about you: • For workers’ ' compensation claims • For law enforcement purposes or with a law enforcement official • With health oversight agencies for activities authorized by law • For special Special government functions such as include military, national security, and presidential protective services services. Respond to lawsuits and legal actions • We can share health information about you in response to a court or administrative order, order or in response reply to a subpoena. Our Responsibilities Assist in fundraising activities We can use or share health information for purposes of fundraising activities within these guidelines: • The information used or disclosed must be limited to your demographic information and the health care dates. • If we are not preparing the fundraising within our organization, the information can only be disclosed to a business associate or an institutionally related foundation. • Any fundraising materials must include a description of how you can opt-out of future fundraising communications. • Your PHI will not be used for fundraising activities unless you provide authorization for the fundraising activity. • Upon authorization of your use of PHI in a fundraising activity, we will provide instructions on how you may opt-out of future fundraising communications or revoke the authorization relating to these activities. • We will maintain a log of all individuals who have revoked fundraising authorizations or opted out of receiving future communications. • We must make reasonable efforts to ensure that you do not receive further fundraising materials if you have revoked your authorization or exercised your opt-out rights. OUR RESPONSIBILITIES • We are required by law to maintain the privacy and security of your PHI, and other nonpublic, personal protected health information. • We will let promptly inform you know promptly if a breach occurs that may have compromised the your information's privacy or security of your informationsecurity. • We must follow the duties and privacy practices described in this notice and give you a copy of itcopy. • We will not use or share your information other than as described here unless you tell us we can us, in writing, that we may. If you tell us we can, you may change your mind at any timeanytime. Let us know in writing if you change your mind. • Once you authorize us to release your health information, we cannot guarantee that the person to whom the information is provided will not disclose the information. For more information, see xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxxxxx.xxxx CHANGES TO THE TERMS OF THIS NOTICE We establish and enforce security and privacy policies and procedures that protect oral, writtencan change the terms of this notice, and electronic informationthe changes will apply to all information we have about you. • Annual security The new notice will be available upon request on our website, and privacy awareness training we will mail a copy to you. This notice is completed effective: March 2021 STOP LOSS INSURANCE POLICY Alliant Health Plans, Inc. 000 X. Xxxxx Street Dalton, Georgia 30722 (A Georgia Insurance Corporation herein called Alliant) This Policy will be construed under the law of the jurisdiction in which it is delivered. In consideration of premium payments by the entire workforce populationInsured in the amounts and at times provided, Xxxxxxx agrees with the Insured to provide insurance following the Policy terms. • We apply physical For the purpose of effective dates and electronic safeguards to protect termination dates under this Policy, all days begin and prevent unauthorized access to your informationend at midnight. • We limit access to PHI as appropriate for workforce members to complete their jobThis Policy is non- participating. • We provide prospectiveIn Witness Whereof, existingAlliant Health Plans, Inc. has signed this Policy in Dalton, Georgia. Xxxx Xxxxx, President, and former members CEO, Alliant Health Plans, Inc. Alliant Health Plans, Inc. 000 X. Xxxxx Street Dalton, Georgia 30722 Section 1. Declarations STOP LOSS INSURANCE POLICY FOR: INSURED: POLICY EFFECTIVE DATE: See “Plan Sponsor” listed in Stop Loss Application See “Effective Date” listed in Stop Loss Application DATE OF ISSUE: See Stop Loss Application Attach a copy of the same protection and respect of their information. Changes to the Terms of this Notice Questions Please use the contact information provided if you want more information about our privacy practices, have questions or concerns, or would like to file a complaint. Requests sent to persons, offices or addresses other than the one indicated might result in a delayed response. BlueCross BlueShield of Western New York 0-000-000-0000 (TTY 711) 8 a.m. – 7 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Child Health Plus and Medicaid Managed Care 0-000-000-0000 (TTY 711) 8:30 a.m. – 6 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Medicare Advantage, Medigap, Part D Prescription Drug Plan 0-000-000-0000 (TTY 711) October 1 through March 31:Final Quote
Appears in 1 contract
Samples: Administrative Services Agreement
Example. Your company Company contracts with us to provide a health plan, and we provide your company Company with certain specific statistics to explain the premiums we charge. Specific information is not released to employers unless the proper agreements are in place as permitted by law or you have authorized the release. Business associates • We may disclose your health information to our business associates to provide you with products or services on our behalf (such as claims administration or pharmacy benefits management). Business associates are required by law and contract to protect your confidentiality and limit the use of your information. How else can we use or share your health information? • We are allowed or required to share your information in other ways — – usually in ways that contribute to the public good, such as public health and research. We have to However, we must meet many conditions in the law before we can share sharing your information for these purposes. • For more information, see xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxx.xxxx. Help with public health and safety issues We can share health information about you for certain situations such as: • Preventing disease, injury, or disability disease • Helping with product recalls • Reporting adverse reactions to medications • Reporting suspected abuse, neglect, or domestic violence • Preventing or reducing a serious threat to anyone’s 's health or safety safety. Do research • We can use or share your information for health research, subject to certain criteria. Comply with the law • We will share information about you if state or federal laws require it, including with the United States Department of Health and Human Services (HHS) if it wants to see that we’re complying we comply with federal privacy lawslaw. Example: responding • We may report information to a request from state agencies that regulate us, such as the US HHS, the New York State Georgia Department of Financial Services (DFS), the New York State Department of Health (DOH), or other appropriate regulatory authorityInsurance. Respond to organ and tissue donation requests and work with a medical examiner or funeral director • We can share health information about you with organ procurement organizations. • We When an individual dies, we can share health information with a coroner, medical examiner, or funeral director when an individual diesdirector. Address workers’ ' compensation, law enforcement, and other government requests requests. We can use or share health information about you: • For workers’ ' compensation claims • For law enforcement purposes or with a law enforcement official • With health oversight agencies for activities authorized by law • For special Special government functions such as include military, national security, and presidential protective services services. Respond to lawsuits and legal actions • We can share health information about you in response to a court or administrative order, order or in response reply to a subpoena. Our Responsibilities Assist in fundraising activities We can use or share health information for purposes of fundraising activities within these guidelines: • The information used or disclosed must be limited to your demographic information and the health care dates. • If we are not preparing the fundraising within our organization, the information can only be disclosed to a business associate or an institutionally related foundation. • Any fundraising materials must include a description of how you can opt-out of future fundraising communications. • Your PHI will not be used for fundraising activities unless you provide authorization for the fundraising activity. • Upon authorization of your use of PHI in a fundraising activity, we will provide instructions on how you may opt-out of future fundraising communications or revoke the authorization relating to these activities. • We will maintain a log of all individuals who have revoked fundraising authorizations or opted out of receiving future communications. • We must make reasonable efforts to ensure that you do not receive further fundraising materials if you have revoked your authorization or exercised your opt-out rights. OUR RESPONSIBILITIES • We are required by law to maintain the privacy and security of your PHI, and other nonpublic, personal protected health information. • We will let promptly inform you know promptly if a breach occurs that may have compromised the your information's privacy or security of your informationsecurity. • We must follow the duties and privacy practices described in this notice and give you a copy of itcopy. • We will not use or share your information other than as described here unless you tell us we can us, in writing, that we may. If you tell us we can, you may change your mind at any timeanytime. Let us know in writing if you change your mind. • Once you authorize us to release your health information, we cannot guarantee that the person to whom the information is provided will not disclose the information. For more information, see xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxxxxx.xxxx CHANGES TO THE TERMS OF THIS NOTICE We establish and enforce security and privacy policies and procedures that protect oral, writtencan change the terms of this notice, and electronic informationthe changes will apply to all information we have about you. • Annual security The new notice will be available upon request on our website, and privacy awareness training we will mail a copy to you. This notice is completed effective: August 2023 STOP LOSS INSURANCE POLICY Alliant Health Plans, Inc. 000 X. Xxxxx Street Dalton, Georgia 30722 (A Georgia Insurance Corporation herein called Alliant) This Policy will be construed under the law of the jurisdiction in which it is delivered. In consideration of premium payments by the entire workforce populationInsured in the amounts and at times provided, Alliant agrees with the Insured to provide insurance following the Policy terms. • We apply physical For the purpose of effective dates and electronic safeguards to protect termination dates under this Policy, all days begin and prevent unauthorized access to your informationend at midnight. • We limit access to PHI as appropriate for workforce members to complete their jobThis Policy is non- participating. • We provide prospectiveIn Witness Whereof, existingAlliant Health Plans, Inc. has signed this Policy in Dalton, Georgia. Xxxx Xxxxx, President, and former members the same protection and respect of their informationCEO, Alliant Health Plans, Inc. Alliant Health Plans, Inc. 000 X. Xxxxx Street Dalton, Georgia 30722 Section 1. Changes to the Terms of Declarations STOP LOSS INSURANCE POLICY FOR: INSURED: POLICY EFFECTIVE DATE: See “Plan Sponsor” listed in Stop Loss Application See “Effective Date” listed in Stop Loss Application DATE OF ISSUE: See Stop Loss Application The Final Quote attached hereto is incorporated by reference into this Notice Questions Please use the contact information provided if you want more information about our privacy practices, have questions or concerns, or would like to file a complaint. Requests sent to persons, offices or addresses other than the one indicated might result in a delayed response. BlueCross BlueShield of Western New York 0-000-000-0000 (TTY 711) 8 a.m. – 7 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Child Health Plus and Medicaid Managed Care 0-000-000-0000 (TTY 711) 8:30 a.m. – 6 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Medicare Advantage, Medigap, Part D Prescription Drug Plan 0-000-000-0000 (TTY 711) October 1 through March 31:Section 1.
Appears in 1 contract
Samples: Administrative Services Agreement
Example. Your company contracts with us We give information about you to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge. Specific information is not released to employers unless the proper agreements are in place as permitted by law or you have authorized the release. Business associates • We may disclose your health information to our business associates to provide you with products or services on our behalf (such as claims administration or pharmacy benefits management). Business associates are required by law and contract to protect insurance plan so it will pay for your confidentiality and limit the use of your informationservices. How else can we use or share your health information? We are allowed or required to share your information in other ways — – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. Help with public health and safety issues We can share health information about you for certain situations such as: • Preventing disease, injury, or disability • disease / Helping with product recalls / Reporting adverse reactions to medications /Reporting suspected abuse, neglect, or domestic violence • Preventing and preventing or reducing a serious threat to anyone’s health or safety Do research • research- We can use or share your information for health research, subject to certain criteria. Comply with the law • We will share information about you if state or federal laws require it, including with the United States Department of Health and Human Services (HHS) if it wants to see that we’re complying with federal privacy laws. Example: responding to a request from the US HHS, the New York State Department of Financial Services (DFS), the New York State Department of Health (DOH), or other appropriate regulatory authoritylaw. Respond to organ and tissue donation requests and work with a medical examiner or funeral director • We -We can share health information about you with organ procurement organizations. • Work with a medical examiner or funeral director We can share health information with a coroner, medical examiner, or funeral director when an individual dies. Address workers’ compensation, law enforcement, and other government requests We can use or share health information about you: • For workers’ compensation claims • For law enforcement purposes or with a law enforcement official • With health oversight agencies for activities authorized by law • For special government functions such as military, national security, and presidential protective services Respond to lawsuits and legal actions • We can share health information about you in response to a court or administrative order, or in response to a subpoena. Our Responsibilities • We are required by law to maintain the privacy and security of your PHI, and other nonpublic, personal protected health information. • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. • We must follow the duties and privacy practices described in this notice and give you a copy of it. • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. • We establish and enforce security and privacy policies and procedures that protect oral, written, and electronic information. • Annual security and privacy awareness training is completed by the entire workforce population. • We apply physical and electronic safeguards to protect and prevent unauthorized access to your information. • We limit access to PHI as appropriate for workforce members to complete their job. • We provide prospective, existing, and former members the same protection and respect of their information. Changes to the Terms of this Notice Questions Please use the contact information provided if you want more information about our privacy practices, have questions or concerns, or would like to file a complaint. Requests sent to persons, offices or addresses other than the one indicated might result in a delayed response. BlueCross BlueShield of Western New York 0-000-000-0000 (TTY 711) 8 a.m. – 7 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Child Health Plus and Medicaid Managed Care 0-000-000-0000 (TTY 711) 8:30 a.m. – 6 p.m., Monday – Friday PO Box 80, Buffalo, NY 14240-0080 Medicare Advantage, Medigap, Part D Prescription Drug Plan 0-000-000-0000 (TTY 711) October 1 through March 31:.
Appears in 1 contract
Samples: Therapy Agreement
