Notice of Elderplan Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
By law, Elderplan is required to protect the privacy of your personal medical information. Elderplan is also required to give you this notice to tell you how Elderplan may use and give out (“disclose”) your personal medical information held by Elderplan.
Elderplan must use and give out your personal medical information to provide information:
1. To you or someone who has the legal right to act for you (your personal representative)
2. To the Secretary of the Department of Health and Human Services, if necessary, to make sure your privacy is protected; and
3. Where required by law.
Elderplan has the right to use and give out your personal medical information to pay for your health care and to operate the Elderplan program. For example:
1. Elderplan uses your personal medical information to pay or deny your claims, to share your benefit payment with your other insurer(s), or to prepare your Elderplan Explanation of Benefits Notice.
2. Elderplan may use your personal medical information to make sure you and other Elderplan members get quality health care, to provide customer services to you, or to resolve any complaints you have.
Elderplan may use or give out your personal medical information for the following purposes under limited circumstances:
1. To State and other federal agencies that have the legal right to receive Elderplan data (such as to make sure Elderplan is making proper payments and to assist federal/state Medicaid programs),
2. For public health activities (such as reporting disease outbreaks),
3. For government health care oversight activities (such as fraud and abuse investigations),
4. For judicial and administrative proceedings (such as in response to a court order),
5. For law enforcement purposes (such as providing limited information to locate a missing person),
6. For research studies that meet all privacy law requirements (such as research related to the prevention of disease or disability),
7. To avoid a serious and imminent threat to health or safety,
8. To contact you about new or changed benefits or treatment options available under Elderplan, and
9. To create a collection of information that can no longer be traced back to you.
10. If you do not object, we may share your health information with a family member, relative, or close personal friend who is involved in your care or payment for that care.
11. If you do not object, we may use demographic information about you (or share it with a charitable foundation acting on our behalf), including information about your age and gender, when deciding whether to contact you or your personal representative to raise money to help us operate.
By law, Elderplan must have your written permission (an “Authorization”) to use or give out your personal medical information for any purpose that is not set out in this notice. You may take back (“revoke”) your written permission at any time, except if Elderplan has already acted based on your permission.
By law, you have the right to:
1. See and get a copy of your personal medical information held by Elderplan.
2. Have your personal medical information amended if you believe that it is wrong or if information is missing, and Elderplan agrees. If Elderplan disagrees, you may have a statement of your disagreement added to your personal medical information.
3. Get a listing of those getting your personal medical information from Elderplan (an “Accounting”). The Accounting will not cover disclosures of your personal medical information that were given to you or your personal representative, that were given out to pay for your health care or for Elderplan operations, or that were given out for law enforcement purposes.
4. Ask Elderplan to communicate with you in a different manner or at a different place (for example, by sending materials to a P.O. box instead of your home address).
5. Ask Elderplan to limit how your personal medical information is used and given out to pay your claims and operate the Elderplan program. Please note that Elderplan may not be able to agree to your request.
6. Get a separate paper copy of this notice.
If you believe Elderplan has violated your privacy rights as described in this notice, you may file a complaint with Elderplan at the following address: Privacy Complaints Attn: Elderplan Privacy Officer 6323 Seventh Avenue Brooklyn, NY 11220
Filing a complaint will not affect your benefits under Elderplan.
You also may file a complaint with the Secretary of the Department of Health and Human Services.
For more information on filing a complaint or exercising your rights set out in this notice, call the Elderplan Privacy Officer at (718) 759-4700 between the hours of 9:00 a.m. and 5:00 p.m., Monday through Friday.
By law, Elderplan is required to follow the terms in this privacy notice. Elderplan has the right to change the way your personal medical information is used and given out. If Elderplan makes any changes, you will get a new notice by mail within 60 days of the change.
The privacy practices are effective October 20, 2006. H9101_H3347_EP06125
