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NOTICE
OF PRIVACY PRACTICES
To offer benefits to First Choice members, Select Health of
South Carolina shares your personal health information with
your doctors, hospitals, and others involved in your health
care. All who handle your information - our employees, your
First Choice providers, and others - are dedicated to keeping
your information private. We treat your personal health information
as required by state and federal laws.
The
attached notice tells you about your privacy rights, about
the ways we may use your personal health information and when
we may share it with others. For instance, we use your health
information to provide you with benefits. We share your information
to help with your treatment or to help your doctors receive
payment. We may share information with other insurance companies
to receive payment. We may use the information within Select
Health to measure and improve the quality of our service to
you, as required by law or according to Select Health policies.
Please
read the enclosed notice of privacy practices. If you have
any questions about the notice, or if you would like more
information about privacy laws, please call your member services
representative toll-free at 1-888-276-2020 and ask to speak
with the Select Health Privacy Official. You may also learn
more about privacy laws and the Health Insurance Portability
and Accountability Act (HIPAA) at the web sites, www.hipaa.state.sc.us
or www.hhs.gov/ocr/hipaa/privacy.html.
NOTICE
OF PRIVACY PRACTICES
Select Health of South Carolina, Inc.
PO Box 40849
Charleston, SC 29423-0849
(843)569-1759
Effective
date of this notice: April 14, 2003
If
you have questions about this notice, please contact the person
listed under "Whom to Contact" at the end of this
notice.
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.
SUMMARY
In order to provide you with benefits, SHSC will create and/or
receive personal information about your health, from you,
your physicians, hospitals, and others who provide you with
health care services. We are required to keep this information
confidential. This notice of our privacy practices is intended
to inform you of the ways we may use your information and
the occasions on which we may disclose this information to
others.
Occasionally,
we may use Members' information when providing treatment.
We use members' health information to provide benefits. We
disclose members' information to health care providers to
assist them to provide you with treatment or to help them
receive payment, we may disclose information to other insurance
companies as necessary to receive payment, we may use the
information within our organization to evaluate quality and
improve health care operations, and we may make other uses
and disclosures of members' information as required by law
or as permitted by SHSC policies.
KINDS
OF INFORMATION THAT THIS NOTICE APPLIES TO
This notice applies to any information in our possession that
would allow someone to identify you and learn something about
your health. It does not apply to information that contains
nothing that could reasonably be used to identify you.
WHO
MUST ABIDE BY THIS NOTICE
- SHSC
- All
employees, staff, interns, volunteers and other personnel
whose work is under the direct control of SHSC.
We at SHSC have agreed to abide by its terms. We may share
your information with each other for purposes of treatment,
and as necessary, for payment and operations activities
as described below.
OUR
LEGAL DUTIES
- We
are required by law to maintain the privacy of your health
information
- We
are required to provide this notice of our privacy practices
and legal duties regarding health information to you.
- We
are required to abide by the terms of this notice until
we officially adopt a new notice.
HOW
WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION.
We may use your health information, or disclose it to others,
for a number of different reasons. This notice describes these
reasons. For each reason, we have written a brief explanation.
We also provide some examples. These examples do not include
all of the specific ways we may use or disclose your information.
But any time we use your information, or disclose it to someone
else, it will fit one of the reasons listed here.
1.
Treatment. We may use your health information to provide
you with medical care and services. This means that our employees,
staff, interns, volunteers and others whose work is under
our direct control, may read your health information to learn
about your medical condition and use it to help you make decisions
about your care. For instance, one of our nurses may take
your blood pressure at a health fair. We will also disclose
your information to others to provide you with medical treatment
or services. For instance, we may use health information to
identify members with certain chronic illnesses, and send
information to them or to their doctors regarding treatment
alternatives.
2. Payment. We may use your health information, and
disclose it to others, as necessary to make payment for the
health care services you receive. For instance, an employee
in our claim processing department may use your health information
to pay your claims. And we may send information about you
and your claim payments to the doctor or hospital that provided
you with health care services. We may also send you information
about claims we pay and claims we do not pay (called an "explanation
of benefits"). The explanation of benefits will include
information about claims we receive for you or your family
member. Under certain circumstances, you may receive this
information confidentially (see the "Confidential Communication"
section in this notice). We may also disclose some of your
health information to companies with whom we contract for
payment-related services. For instance, we may give information
about you to a claims processing company that we contract
with to help us pay claims. We will not use or disclose more
information for payment purposes than is necessary.
3. Health Care Operations. We may use your health
information for activities that are necessary to operate our
organization. This includes, for example, reading your health
information to review the performance of our staff. We may
also use your information and the information of other members
to plan what services we need to provide, expand, or reduce.
We may disclose your health information as necessary to others
who we contract with to provide administrative services. This
includes our lawyers, auditors, accreditation services, and
consultants, for instance.
4.
Legal Requirement to Disclose Information. We will disclose
your information when we are required by law to do so. This
includes reporting information to government agencies that
have the legal responsibility to monitor the health care system.
For instance, we may be required to disclose your health information,
and the information of others, if we are audited by the state
insurance or health department. We will also disclose your
health information when we are required to do so by a court
order or other judicial or administrative process.
5. Public Health Activities. We will disclose your
health information when required to do so for public health
purposes. This includes reporting certain diseases, births,
deaths, and reactions to certain medications. It may also
include notifying people who have been exposed to a disease.
6. To Report Abuse. We may disclose your health information
when the information relates to a victim of abuse, neglect
or domestic violence. We will make this report only if there
are laws that require or allow such reporting (or with your
permission).
7. Law Enforcement. We may disclose your health information
for law enforcement purposes. This includes providing information
to help locate a suspect, fugitive, material witness or missing
person, or in connection with suspected criminal activity.
We must also disclose your health information to a federal
agency reviewing our compliance with federal privacy regulations.
8. Specialized Purposes. We may disclose your health
information for a number of other specialized purposes. We
will only disclose as much information as is necessary for
the purpose. For example, we may disclose the health information
of members of the armed forces as authorized by military command
authorities. As another example, we may disclose your information
to coroners, medical examiners and funeral directors; to organ
procurement organizations (for organ, eye, or tissue donation);
or for national security, intelligence, and protection of
the president. We also may disclose health information about
an inmate to a correctional institution or to law enforcement
officials, to provide the inmate with health care, to protect
the health and safety of the inmate and others, and for the
safety, administration, and maintenance of the correctional
institution.
9. To Avert a Serious Threat. We may disclose your
health information if we decide that the disclosure is necessary
to prevent serious harm to the public or to an individual.
The disclosure will only be made to someone who is able to
prevent or reduce such a threat.
10. Family and Friends. We may disclose your health
information to a member of your family or to someone else
who is involved in your medical care or payment for care.
This may include telling a family member about the status
of a claim, or what benefits you are eligible to receive.
In the event of a disaster, we may provide information about
you to a disaster relief organization so they can notify your
family of your condition and location. We will not disclose
your information to family or friends if you object.
11. Research. We may disclose your health information
in connection with medical research projects. Federal rules
govern any disclosure of your health information for research
purposes without your authorization.
12. To Provide Information to You. We may use your
health information to provide you with additional information.
This may include sending appointment reminders to your address.
This may also include giving you information about treatment
options, alternative setting for care, or other services that
we provide or can arrange for you.
YOUR
RIGHTS
1.
Authorization. We may use or disclose your health information
for any purpose that is listed in this notice without your
written authorization. We will not use or disclose your health
information for any other reason without your authorization.
If you authorize us to use or disclose your health information,
you have the right to revoke that authorization at any time.
For information about how to authorize us to use or disclose
your health information, or about how to revoke an authorization,
contact the person listed under "Whom to Contact"
at the end of this notice. You may not revoke an authorization
for us to use and disclose your information to the extent
that we have taken action in reliance on the authorization.
If the authorization is to permit disclosure of your information
to an insurance company, as a condition of obtaining coverage,
other law may allow the insurer to continue to use your information
to contest claims or your coverage, even after you have revoked
the authorization.
2. Request Restrictions. You have the right to ask
us to restrict how we use or disclose your health information.
We will consider your request. But we are not required to
agree. If we do agree, we will comply with the request unless
the information is needed to provide you with emergency treatment.
We cannot agree to restrict disclosures that are required
by law.
3. Confidential Communication. If you believe that
the disclosure of certain information could endanger you,
you have the right to ask us in writing to communicate with
you at a special address or by a special means. For example,
you may ask us to send explanations of benefits that contain
your health information to a different address rather than
to your home. Or you may ask us to speak to you personally
on the telephone rather than sending your health information
by mail. We will agree to any reasonable request.
4. Inspect And Receive a Copy of Health Information.
You have a right to inspect the health information about you
that we have in our records, and to receive a copy of it.
This right is limited to information about you that is kept
in records that are used to make decisions about you. For
instance, this includes claim and enrollment records. If you
want to review or receive a copy of these records, you must
make the request in writing. We may charge you a fee for the
cost of copying and mailing the records. To ask to inspect
your records, or to receive a copy, contact the person listed
under "Whom to Contact" at the end of this notice.
We will respond to your request within 30 days. We may deny
you access to certain information. If we do, we will give
you the reason, in writing. We will also explain how you may
appeal the decision.
5. Amend Health Information. You have the right to
ask us to amend health information about you which you believe
is not correct, or not complete. You must make this request
in writing, and give us the reason you believe the information
is not correct or complete. We will respond to your request
in writing within 30 days. We may deny your request if we
did not create the information, if it is not part of the records
we use to make decisions about you, if the information is
something you would not be permitted to inspect or copy, or
if it is complete and accurate.
6. Accounting of Disclosures. You have a right to receive
an accounting of certain disclosures of your information to
others. This accounting will list the times we have given
your health information to others. The list will include dates
of the disclosures, the names of the people or organizations
to whom the information was disclosed, a description of the
information, and the reason. We will provide the first list
of disclosures you request at no charge. We may charge you
for any additional lists you request during the following
12 months. You must tell us the time period you want the list
to cover. You may not request a time period longer than seven
years. We cannot include disclosures made before April 14,
2003. Disclosures for the following reasons will not be included
on the list: disclosures for treatment, payment, or health
care operations; disclosures for national security purposes;
disclosures to correctional or law enforcement personnel;
disclosures in emergency situations; disclosures that you
have authorized; and disclosures made directly to you. Requests
for Accounting of Disclosure should be sent in writing to
the person listed under "Whom to Contact" at the
end of this notice.
7. Paper Copy of this Privacy Notice. You have a right
to receive a paper copy this notice. If you have received
this notice electronically, you may receive a paper copy by
contacting the person listed under "Whom to Contact"
at the end of this notice.
8. Complaints. You have a right to complain about
our privacy practices, if you think your privacy has been
violated. You may file your complaint with the person listed
under "Whom to Contact" at the end of this notice.
You may also file a complaint directly with the Secretary
of the U. S. Department of Health and Human Services, at the
Office for Civil Rights, U.S. Department of Health and Human
Services, 200 Independence Avenue, S.W., Room 509F HHH Bldg.,
Washington, D.C. 20201. All complaints to the Secretary must
be in writing. We will not take any action against you if
you file a complaint.
OUR
RIGHT TO CHANGE THIS NOTICE
We
reserve the right to change our privacy practices, as described
in this notice, at any time. We reserve the right to apply
these changes to any health information which we already have,
as well as to health information we receive in the future.
Before we make any change in the privacy practices described
in this notice, we will write a new notice that includes the
change. The new notice will include an effective date. We
will mail the new notice to our members within 60 days of
the effective date.
WHOM
TO CONTACT.
Contact the person listed below:
- For
more information about this notice, or
- For
more information about our privacy policies, or
- If
you want to exercise any of your rights, as listed on this
notice, or
- If
you want to request a copy of our current notice of privacy
practices.
CONTACT
MEMBER SERVICES AND ASK TO SPEAK WITH
The Select Health Privacy Official
AT
1-(888)276-2020
SELECT HEALTH OF SOUTH CAROLINA, INC.
PO BOX 40849
CHARLESTON, SC 29423-0849
This
notice is also available by e-mail. Contact the Privacy Official,
or send an e-mail to:
privacyofficial@selecthealthofsc.com
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