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Your
Privacy Matters
In compliance with the
Health Insurance Portability and AccountabilityAct (HIPAA), Coventry Health
Care is sending you important information about how your medical and
personal information may be used and about how you can access this information.
Please review the Notice of Privacy Practices carefully. If you have any
questions, please call the Member Services number on the back of your
membership identification card.
Notice
of Privacy Practices
Effective:
4/14/2003
THIS NOTICE DESCRIBES HOW
MEDICAL AND PERSONAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW
YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
A.
Our Commitment to Your Privacy
We understand the
importance of keeping your personal and health information secure and private.
We are required by law to provide you with this notice. This notice informs you
of your rights about the privacy of your personal information and how we may
use and share your personal information. We will make sure that your personal
information is only used and shared in the manner described. We may, at times,
update this notice. Changes to this notice will apply to the information that
we already have about you as well as any information that we may receive or
create in the future. Our current notice is posted at www.cvty.com. You may
request a copy at any time. Throughout this notice, examples are provided.
Please note that all of these examples may not apply to the services Coventry
provides to your particular health benefit plan.
B.
What Types of Personal Information Do We Collect?
To best service your
benefits, we need information about you. This information may come from you,
your employer, or other payors or health benefits plan sponsors, and our
affiliates. Examples include your name, address, phone number, Social Security
number, date of birth, marital status, employment information, or medical
history. We also receive information from health care providers and others
about you. Examples include the health care services you receive. This
information may be in the form of health care claims and encounters, medical
information, or a service request. We may receive your information in writing,
by telephone, or electronically.
C.
How Do We Protect the Privacy of Your Personal Information?
Keeping your information
safe is one of our most important duties. We limit access to your personal
information to those who need it. We maintain appropriate safeguards to protect
it. For example, we protect access to our buildings and computer systems. Our
Privacy Office also assures the training of our staff on our privacy and
security policies.
D.
How Do We Use and Share Your Information for Treatment, Payment, and Health
Care Operations?
To properly service your
benefits, we may use and share your personal information for “treatment,”
“payment,” and “health care operations.” Below we provide examples of each. We
may limit the amount of information we share about you as required by law. For
example, HIV/AIDS, substance abuse, and genetic information may be further
protected by law. Our privacy policies will always reflect the most protective
laws that apply.
Treatment:
We may use and share your personal information with health care providers for
coordination and management of your care. Providers include physicians,
hospitals, and other caregivers who provide services to you.
Payment:We
may use and share your personal information to determine your eligibility,
coordinate care, review medical necessity, pay claims, obtain external review,
and respond to complaints. For example, we may use information from your health
care provider to help process your claims. We may also use and share your
personal information to obtain payment from others that may be responsible for
such costs.
Health
Care Options:
We may use and share your
personal information as part of our operations in servicing your benefits.
Operations include credentialing of providers; quality improvement activities;
accreditation by independent organizations; responses to your questions, or
grievance or external review programs; and disease management, case management,
and care coordination. We may also use and share information for our general
administrative activities such as pharmacy benefits administration; detection
and investigation of fraud; auditing; underwriting and rate-making; securing
and servicing reinsurance policies; or in the sale, transfer, or merger of all
or a part of a Coventry company with another entity. For example, we may use or
share your personal information in order to evaluate the quality of health care
delivered, to remind you about preventive care, or to inform you about a
disease management program.
We may also share your
personal information with providers and other health plans for their treatment,
payment, and certain health care operation purposes. For example, we may share
personal information with other health plans identified by you or your plan
sponsor when those plans may be responsible to pay for certain health care
benefits.
E.
What Other Ways Do We Use or Share Your Information?
We
may also use or share you personal information for the following:
Health care oversight
and law enforcement: To comply with federal or state oversight
agencies. These may include your state department of insurance or the U.S.
Department of Labor.
Legal
proceedings:To comply with a court order or other lawful process.
Treatment options:
To inform you about treatment options or health-related benefits or services.
Plan sponsors:
To permit the sponsor of your health plan to service your benefits. Please see
your plan documents for more information.
Research:
To researchers where all procedures required by law have been taken to protect
the privacy of the data.
Others
involved in your health care: We may share certain personal
information with a relative, such as your spouse, close personal friend, or
others you have identified as being involved in your care or payment for that
care. For example, to those individuals with knowledge of a specific claim, we
may confirm certain information about it.Also, we may mail an explanation of
benefits to the subscriber. Your family may also have access to such
information on our Web site. If you do not want this information to be shared,
please tell us in writing.
Personal
representatives: We may share personal information with those
having a relationship that gives them the right to act on your behalf. Examples
include parents of an unemancipated minor or those having a Power of Attorney.
Business associates:
To persons providing services to us and who assure us that they will protect
the information. Examples may include those companies providing your pharmacy
or behavioral health benefits.
Other
situations: We also may share personal information in certain
public interest situations. Examples include protecting victims of abuse or
neglect; preventing a serious threat to health or safety; tracking diseases or
medical devices; or informing military or veteran authorities if you are an
armed forces member. We may also share your information with coroners; for
workers’ compensation; for national security; and as required by law.
F.
What About Other Sharing of Information and What Happens If You Are No Longer
Enrolled?
We will obtain your
written permission to use or share your health information for reasons not
identified by this notice and not otherwise permitted or required by law. If
you withdraw your permission, we will no longer use or share your health
information for those reasons. We do not destroy your information when your
coverage ends. It is necessary to use and share your information, for many of
the purposes described above, even after your coverage ends. However, we will
continue to protect your information regardless of your coverage status.
G.
Rights Established by Law
Requesting
restrictions: You can request a restriction on the use or sharing
of your health information for treatment, payment, or health care operations.
However, we may not agree to a requested restriction.
Confidential
communications: You can request that we communicate with you about
your health andrelated issues in a certain way, or at a certain location. For
example, you may ask that we contact you by mail, rather than by telephone, or
at work, rather than at home. We will accommodate reasonable requests.
Access
and copies: You can inspect and obtain a copy of certain health
information. We may charge a fee for the costs of copying, mailing, labor, and
supplies related to your request. We may deny your request to inspect or copy
in some situations. In some cases denials allow for a review of our decision.
We will notify you of any costs pertaining to these requests, and you may
withdraw your request before you incur any costs.
Amendment:
You may ask us to amend your health information if you believe it is incorrect
or incomplete. You must provide us with a reason that supports your request. We
may deny your request if the information is accurate, or as otherwise allowed
by law. You may send a statement of disagreement.
Accounting of
disclosures: You may request a report of certain times we have
shared your information. Examples include sharing your information in response
to court orders or with government agencies that license us.All requests for an
accounting of disclosures must state a time period that may not include a date
earlier than six years prior to the date of the request and may not include
dates beforeApril 14, 2003. We will notify you of any costs pertaining to these
requests, and you may withdraw your request before you incur any costs.
H.
To Receive More Information or File a Complaint
Please contact Member
Services to find out how to exercise any of your rights listed in this notice,
or if you have any questions about this notice. The telephone number or address
is listed in your benefit documents or on your membership card. If you believe
we have not followed the terms of this notice, you may file a complaint with us
or with the Secretary of the Department of Health and Human Services. To file a
complaint with the Secretary, write to 200 Independence Avenue, S.W.
Washington, D.C. 20201 or call 1-877-696-6775. You will not be penalized for
filing a complaint. To contact us, please follow the complaint, grievance, or
appeal process in your benefit documents.
i For
purposes of this notice, the pronouns "we", "us" and "our" and the name
"Coventry" refers to Coventry Health Care, Inc. and its licensed affiliated
companies, including, but not limited to,AltiusHealth Plans, Inc.; Cambridge
Life Insurance Company; Carelink Health Plans, Inc.; Coventry Health Care of
Delaware, Inc.; Coventry Health Care of Georgia, Inc.; Coventry Health Care of
Iowa, Inc.; Coventry Health Care of Nebraska, Inc.; Coventry Health Care of
Pennsylvania, Inc.; Coventry HealthCare of Louisiana, Inc.; Coventry Health and
Life Insurance Company; Coventry Health Care of Kansas, Inc.; Coventry Health
Care NationalAccounts, Inc.; First Health Life & Health Insurance Company;
FirstHealth Services Corp.; Group Health Plan, Inc.; HealthAmerica
Pennsylvania, Inc., HealthAssurancePennsylvania, Inc., HealthCare USAof
Missouri, L.L.C.; OmniCare Health Plan, Inc.; PersonalCare Insurance of
Illinois, Inc.; Southern Health Services, Inc.; Summit Health Plan, Inc.; Vista
Healthplan, Inc.; Vista Healthplan of South Florida, Inc.; Vista Insurance
Plan, Inc
ii Under
various laws, different requirements can apply to different types of
information. Therefore we use the term "health information" to mean information
concerning the provision of, or payment for, health care that is individually
identifiable. We use the term "personal information" to include both health
information and other nonpublic identifiable information that we obtain in
providing benefits to you.
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