Portability and Accountability Act of
INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO
THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
If you have any questions about this Notice, please contact the Privacy Contact.
Plan Providence Health and Welfare Benefit Plan Plan
Providence Health & Services Group Insurance Plan
Privacy Contact Providence (PSMS) Integrity Providence Health & Services 1801 Lind Avenue SW #9016 Renton, WA 98057-9016 Telephone: 1-425-525-3705
and Clinical Health Act (“HITECH”) and the Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules under the Health Information Technology for Economic and Clinical Health Act and the Genetic Information Nondiscrimination Act; Other Modifications to the HIPAA Rules (collectively “HIPAA”), this Notice describes the legal obligations of Providence Health & Services (“Providence”) and the Providence Health and Welfare Benefit Plan group health plan (the “Plan”) regarding your protected health information (“PHI”) held by the Plan.
Among other things, this Notice describes how your PHI may be used or disclosed to carry out treatment, payment, or health care operations, or for any other purposes that are permitted or required by law.
PHI means any information, including demographic information, that is created or received by a
covered entity or an employer and relates to: ● the past, present, or future physical or mental
health or condition of an individual;
● the provision of health care to an individual; or ● the past, present, or future payment for the
provision of health care to an individual; ● and that identifies the individual or for
which there is a reasonable basis to believe the information can be used to identify the individual. PHI includes information concerning persons living or deceased and may be written, oral, or electronic.
We understand that your PHI is personal. We are committed to protecting your PHI. We create a record of the health care claims reimbursed under the Plan for Plan administrative purposes. This Notice applies to all of the medical records we maintain in connection with the Plan’s group health plan benefits. Your personal doctor or health care provider may have different policies or notices regarding the doctor’s use and disclosure of your PHI created in the doctor’s office or clinic. An insurer that insures group health plan benefits of the Plan may have different policies or notices regarding the insurer’s use and disclosure of your
This Notice tells you about the ways in which we may use and disclose your PHI. It also describes our obligations and your rights regarding the use and disclosure of your PHI.
Our Responsibilities We are required by law to:
● Maintain the privacy of your PHI;
● Provide you with certain rights with respect to your PHI;
● Provide you with this Notice of our legal duties and privacy practices with respect to your PHI; and
● Follow the terms of the Plan’s Notice of Privacy Practices that is currently in effect.
How We May Use and Disclose Your PHI The following categories describe different ways that we use and disclose PHI. For each category of uses or disclosures we explain what we mean and give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
For Treatment (as described in the Privacy Regulations). We may use or disclose your PHI
to facilitate medical treatment or services by providers. We may disclose your PHI to providers, including doctors, nurses, technicians, medical students, or other hospital personnel, who are involved in taking care of you.
For Payment (as described in the Privacy
Regulations). We may use and disclose your PHI to
determine eligibility for Plan benefits, to facilitate payment for the treatment and services you receive from health care providers, to determine benefit responsibility under the Plan, or to coordinate Plan coverage. For example, we may tell your health care provider about your medical history to determine whether a particular treatment is experimental, investigational, or medically necessary or to determine whether the Plan will cover the treatment. Likewise, we may share your PHI with another entity to assist with the adjudication or subrogation of health claims or to
your PHI for other Plan operations. These uses and disclosures are necessary to run the Plan. For example, we may use your PHI in connection with: conducting quality assessment and improvement activities; underwriting, premium rating, and other activities relating to Plan coverage; submitting claims for stop-loss (or excess loss) coverage; conducting or arranging for medical review, legal services, audit services, and fraud abuse detection programs; business planning and development such as cost management; and business management and general Plan administrative activities.
The Plan may not use or disclose PHI that
constitutes genetic information for underwriting purposes.
Plan Sponsor. For purposes of administering the
Plan, we may disclose your PHI to certain employees of Providence. However, those employees will only use or disclose that information to perform Plan administration functions, including payment and health care operations, or as otherwise required by HIPAA or state law, unless you have authorized further disclosures. Your PHI cannot be used for employment purposes without your specific authorization. For a more detailed explanation of the limited ways that we may use or disclose your PHI, please refer to the Plan document and/or any applicable amendments.
Business Associates. We contract with service
providers – called business associates – to perform various functions on its behalf. For example, the Plan contracts with a service provider to perform the administrative functions necessary to pay your claims for dental benefits. To perform these functions or to provide the services, business associates will receive, create, maintain, use, or disclose PHI, but only after the Plan and the business associate agree in writing to contract terms requiring the business associate to appropriately safeguard your PHI.
The Plan will comply with requirements of HIPAA and its requirements to provide notification to
breach, as defined under HIPAA, of unsecured PHI.
Organized Health Care Arrangement. Providence
Health & Services Providence Health and Welfare Benefit Plan Welfare Plan, other group health plans sponsored by Providence and its affiliates and the insurers, if any, of benefits provided under the group health plans are an organized health care arrangement within the meaning of the Privacy Regulations. As such, members of the organized health care arrangement may share your protected health information with each other to carry out payment and health care activities on behalf of the group health plans.
Other Covered Entities. We may use or disclose
your PHI to assist health care providers in connection with their treatment or payment activities, or to assist other covered entities in connection with certain health care operations. For example, the Plan may disclose your PHI to a health care provider when needed by the provider to render treatment to you. The Plan may disclose PHI to another covered entity to conduct health care operations in the areas of quality assurance and improvement activities, or accreditation, certification, licensing, or credentialing. This also means that the Plan may disclose or share your PHI with other health care programs or insurance carriers in order to coordinate benefits, if you or your family members have other health insurance or coverage.
As Required by Law. We will disclose your PHI
when required to do so by federal, state, or local law. For example, we may disclose your PHI when required by a court order in a litigation proceeding such as a malpractice action.
To Avert a Serious Threat to Health or Safety. We
may use and disclose your PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure would only be to someone able to help prevent the threat. For example, we may disclose your PHI in a proceeding regarding
Disclosures to Your Personal
Representative and Family Members Your Personal Representative. The Plan will
disclose your PHI to an individual who has been designated by you as your personal representative and who has qualified for such designation in accordance with relevant law. Prior to such a disclosure, however, the Plan must be given written documentation that supports and establishes the basis for the personal representation. The Plan may elect not to treat the person as your personal representative if it has a reasonable belief that you have been, or may be, subjected to domestic violence, abuse, or neglect by such person; treating such person as your personal representative could endanger you; or the Plan determines, in the exercise of its professional judgment, that it is not in your best interest to treat the person as your personal representative.
Others Involved in Your Care. The Plan may
disclose your PHI to a friend or family member who is involved in your health care, unless you object or request a restriction (as provided below). The Plan also may also disclose your information to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location. If you are not present or able to agree to these disclosures of your PHI, then using professional judgment, the Plan may determine whether the disclosure is in your best interest.
Mail to Employee. With only limited exceptions,
we will send all mail to the employee. This includes mail relating to the employee’s spouse and other family members who are covered under the Plan, and it also includes mail with information on the use of Plan benefits by the employee’s spouse and other family members and information on the denial of any Plan benefits to the employee’s spouse and other family members. If a person covered under the Plan has requested restrictions or confidential communications (as provided below), and if we have agreed to the request, we will send mail as provided by the request.
Special Situations When We May Use or Disclose Your Protected Health Care Information
Organ and Tissue Donation. If you are an organ
donor, we may release your PHI to organizations that handle organ procurement or organ, eye, or tissue procurement or transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Military and Veterans. If you are a member of the
armed forces, we may release your PHI as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate foreign military authority.
Workers Compensation. We may release your PHI
for workers compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Public Health Risks. We may disclose your PHI for
public health activities. These activities generally include the following:
● To prevent or control disease, injury or disability;
● To report births and deaths; ● To report child abuse or neglect;
● To report reactions to medications or problems with products;
● To notify people of recalls of products they may be using;
● To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
● To notify the appropriate government
authority if we believe a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
Health Oversight Activities. We may disclose
health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These
programs, and compliance with civil rights laws.
Lawsuits and Disputes. If you are involved in a
lawsuit or a dispute, we may disclose your PHI in response to a court administrative order. We may also disclose your PHI in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Law Enforcement. We may release your PHI if
asked to do so by a law enforcement official: ● In response to a court order, subpoena,
warrant, summons, or similar process; ● To identify or locate a suspect, fugitive,
material witness, or missing person;
● If it pertains to the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
● If it pertains to a death we believe may be the result of criminal conduct;
● If it pertains to criminal conduct at a hospital, clinic, or treatment facility;
● In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
Coroners, Medical Examiners and Funeral Directors. We may release your PHI to a coroner
or medical examiner. This may be necessary to identify a deceased person or determine the cause of death. We may also release your PHI to funeral directors as necessary to carry out their duties.
National Security and Intelligence Activities.
We may release your PHI to authorized federal officials for intelligence, counterintelligence, or other national security activities authorized by law, and for the protection of the President, other authorized persons, or heads of state.
enforcement official, we may release your PHI to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
Required Disclosures
Disclosures to the Secretary of the U.S. Department of Health and Human Services.
The Plan is required to disclose your PHI to the Secretary of the U.S. Department of Health and Human Services when the Secretary is investigating or determining the Plan’s compliance with the Privacy Regulations.
Disclosures to You. The Plan is required to disclose
to you or your personal representative most of your PHI when you request access to this information. Your Rights Regarding Your PHI
You have the following rights regarding PHI we maintain about you:
Right to Inspect and Copy. You have the right to
inspect and copy PHI that may be used to make decisions about your Plan benefits. To inspect and copy PHI that may be used to make decisions about you, you must submit your request in writing to the Regional Privacy Officer. To the extent that PHI is maintained in an electronic health record, you may request that the Plan provide a copy to you or to a person or entity designated by you in an electronic format. If you request a copy of the information, we may charge a reasonable fee for the costs of copying, mailing, or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to PHI, you may request that the denial be reviewed.
Right to Request Amendment. If you feel that the
PHI we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as
To request an amendment, your request must be made in writing and submitted to the Regional Privacy Officer. To the extent that PHI is maintained in an electronic health record, you may request that the Plan provide a copy to you or to a person or entity designated by you in an electronic format. In addition, you must provide a reason that
supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason that supports the request. In addition, we may deny your request if you ask us to amend information that:
● Is not part of the medical information kept by or for the Plan;
● Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
● Is not part of the information which you would be permitted to inspect or copy; or
● Is accurate and complete.
Right to an Accounting of Disclosures. You have
the right to request an accounting of certain disclosures the Plan has made of your PHI.
To request an accounting of disclosures, you must submit your request in writing to the Regional Privacy Officer. Your request must state the time period, which may not be longer than six years and may not include disclosures made before April 14, 2003. Your request should indicate in what form you want the accounting (for example, paper or electronic). The first accounting you request within a twelve month period will be free. For additional accountings, we may charge you for the costs of providing the accountings. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions. You have the
right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the PHI we disclose to someone who is involved in your care or the payment for your care, like a family member or
use or disclose PHI for payment or health care operations purposes for a surgery you had where the surgery costs have been paid out-of-pocket in full by you (in other words, the Plan is not required to pay for any part of the item or service). Other than where the Plan is not required to pay for the medical services you receive, we are not required to agree to your request. To request restrictions, you must make your request in writing to the Regional Privacy Officer. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
Right to Request Confidential Communications.
You have the right to request that we communicate with you about medical matters in a certain way or