THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY.
Dean Health Plan (also referred to as DHP) is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any part of this Notice, or if you want more information about DHP’s privacy practices, please contact our Privacy Officer at 1277 Deming Way, Madison, WI 53717.
How Dean Health Plan May Use
or Disclose Your Health Information
The following categories describe the ways that DHP may use and disclose your health information. For each category of uses and disclosures, we will explain what we mean and, in some cases, present some examples. Not every use or disclosure in a category will be listed. However, all the ways we are permitted to use and disclose information will fall within one of the categories.
1. Payment Functions. We may use or disclose your health information to make payment or to collect payment from third parties, such as other health plans or providers, for the care you receive. For example, we may provide information regarding your coverage or health care treatment to other health plans to coordinate payments of benefits.
2. Health Care Operations. We may use and disclose your health information to carry out necessary insurance-related activities and as necessary to provide coverage and services to you. Health care operations include such activities as:
- Underwriting, premium rating or related functions to create, renew or replace health insurance or health benefits
- Quality assessment and improvement activities
- Activities designed to improve health or reduce health care cost
- Reviewing and evaluating health care provider and health plan performance
- Clinical guideline and protocol development, case management and care coordination
- Accreditation, certification, licensing or credentialing activities
- Training of DHP personnel
- Reviews and auditing, including compliance reviews, medical reviews, legal services, audit services, and compliance programs
- Business planning and development, including cost management and planning, and related analyses and formulary development
- Submitting claims for stop-loss and reinsurance coverage
- Business management and general administrative activities of DHP, including customer service and resolution of internal grievances
- We may contact you or your health care providers with information about treatment alternatives and other related functions that may be of interest to you.
3. For Treatment Alternatives. We may disclose information about you to a health care provider furnishing your care. For example, we may disclose information to a hospital treating you if it requests information about previous treatment or which doctors provided your care.
4. For Distribution of Health-Related Benefits and Services. We may use or disclose your health information to provide information on health-related benefits and services that may be of interest to you.
5. For Disclosure to the Plan. We may disclose summary health information without names or other identifying data to the sponsor of your group health plan for purposes of administering benefits under the plan, soliciting premium bids from health insurers or modifying, amending or terminating the plan. We also may disclose to the plan sponsor information on whether you are participating in the health plan.
6. Required by Law. We may use and disclose your health information as required by any federal, state or local law.
7. Public Health. As required by law, we may disclose your health information to public health authorities for purposes related to (a) preventing or controlling disease, injury or disability, (b) reporting child abuse or neglect, (c) reporting domestic violence, (d) reporting problems with products and reactions to medications to the Food and Drug Administration and (e) reporting disease or infection exposure.
8. Health Oversight Activities. We may disclose your health information to health agencies for authorized activities including audits; civil administrative or criminal investigations; inspections, licensure or disciplinary action; and other proceedings related to oversight of the health care system.
9. In Connection With Judicial and Administrative Proceedings. As permitted or required by state or federal law, we may disclose your health information in the course of any administrative or judicial proceeding. This may be in response to an order of a court or administrative tribunal as expressly authorized by such order, or in response to a subpoena, discovery request or other lawful process. If our disclosure is not in response to an order of a court or administrative tribunal, we must make a reasonable effort to either notify you about the request or to obtain an order protecting your health information.
10. Law Enforcement. As permitted or required by state law, we may disclose health information of a crime victim to a law enforcement official for certain law enforcement purposes including, but not limited to, suspicion that the victim’s death was a result of criminal conduct or in an emergency to report a crime.
11. In the Event of a Serious Threat to Health or Safety. We may, consistent with applicable law and ethical standards of conduct, disclose your health information if we, in good faith, believe that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.
12. For Specified Government Functions. In certain circumstances, federal regulations require us to use or disclose your health information to facilitate specified government functions related to military and veterans, national security and intelligence activities, protective services for the President and others and correctional institutions and inmates.
13. Workers’ Compensation. We may disclose your health information as necessary to comply with workers’ compensation or similar laws.
14. Research. We may disclose your protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.
15. Deceased Persons. We may disclose health information about a deceased person to coroners, medical examiners, funeral directors and organ procurement organizations.
16. Families, Friends and Others Involved in Your Health Care. We may disclose your health information to family members, friends or others that you identify as being involved in your health care or payment for your health care. We may do so with your permission or, if you are present, if you do not object when given the opportunity. If you are incapacitated or are not present, we may use our professional judgment to determine whether the disclosure is in your best interest under the circumstances.
17. Medical Emergency or Disaster Relief Efforts. We may disclose your name, location and general condition to notify or to assist an appropriate public or private agency to locate and notify a person responsible for your health care in appropriate situations, such as a medical emergency or during disaster relief efforts.
When Dean Health Plan May Not Use
or Disclose Your Health Information
We will not use or disclose your health information without your written authorization except as described in this Notice of Privacy Practices. If you do authorize us to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time. If you revoke your authorization, we will no longer be able to use or disclose health information about you for the reasons covered by your written authorization, but we will be unable to take back any disclosures we have already made with your permission.
Statement of Your Health Information Rights
1. Right to Request Restrictions. You have the right to request restrictions on certain uses and disclosures of your health information. However, DHP is not required to agree to the restrictions that you request. If you would like to make a request for restrictions, you must submit your request in writing to our Privacy Officer at the address shown on the last page of this Notice.
2. Right to Request Confidential Communications. You have the right to request that DHP communicate with you in a certain way if you feel the disclosure of your health information could endanger you. For example, you may ask that we only communicate with you at a certain telephone number or by e-mail. If you wish to request confidential communications, you must submit your request in writing to our Privacy Officer. We will attempt to honor your reasonable requests for confidential communications.
3. Right to Inspect and Copy. You have the right to inspect and copy your health information. To inspect and copy your information, you must submit your request in writing to our Privacy Officer. If you request a copy of the information, we may charge you a reasonable fee to cover expenses associated with your request.
4. Right to Request Amendment. You have a right to request that DHP amend health information that you believe is incorrect or incomplete. We are not required to change your health information and if your request is denied, we will provide you with information about our denial and how you can disagree with the denial. To request an amendment, you must make your request in writing to our Privacy Officer. You must also provide the reason for your request.
5. Right to Accounting of Disclosures. We are required by law to keep a record of certain disclosures of your health information and you have the right to receive a list of these disclosures. These may include health information used for public purposes authorized by law or uses that are not in accordance with our privacy policies and applicable law. Your request must be made in writing to our Privacy Officer. The request should specify the time period for which you are requesting the information, but may not start earlier than April 14, 2003. The accounting request may not
be made for periods of time going back more than six (6) years. We will provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee. We will inform you in advance of the fee, if applicable.
6. Right to Paper Copy. You have a right to receive a paper copy of this Notice of Privacy Practices at any time. To obtain a paper copy of this Notice, send your written request to the Customer Service Department at Dean Health Plan, Inc., 1277 Deming Way, Madison WI 53717. You may also obtain a copy of this Notice at our Web site, www.deancare.com.
Duties of Health Plan
We are required by law to maintain the privacy of your health information, and to provide you with this Notice, advising you of our duties and privacy practice requirements. We are required to adhere to the terms of this Notice. DHP reserves the right to amend this Notice of Privacy Practices at any time in the future and to make the new Notice provisions effective for all health information that we maintain. When making material changes, we will promptly revise and distribute our Notice to you. Until such time, DHP is required by law to comply with the current version of this Notice.
Complaints about this Notice of Privacy Practices or how we handle your health information should be submitted in writing to our Privacy Officer. DHP will not retaliate against you in any way for filing a complaint. In addition, if you believe your privacy rights have been violated, you may file a complaint with the Secretary of the Department of Health and Human Services.
The effective date of this Notice is April 14, 2003.
If you have any questions regarding this Notice, please write to us at the following address:
Privacy Officer
Dean Health Plan, Inc.
1277 Deming Way
Madison, WI 53717
800-279-1301
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