NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED, AND HOW YOU ACCESS THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
Dean Health Insurance, Inc. (also referred to as "DHI"), is required by law to maintain the privacy of your health information and provide you with written notification of our legal duties and privacy practices concerning your health information. If you have questions about any part of this Notice, or if you want more information about DHI’s privacy practices, please contact our Privacy Officer at 1277 Deming Way, Madison, Wisconsin 53717.How DHI May Use or Disclose Your Health Information
The following categories describe the ways that DHI may use and disclose your health information. For each category of uses and disclosures, we will explain what we mean and present some examples. Not every use or disclosure will be listed. However, we are allowed to use and disclose information that falls within one of the following categories:
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 health care coverage or treatment to other health plans to coordinate benefit payments.
Health Care Operations. We may use and disclose your health information to carry out necessary insurance-related activities and to provide coverage and services to you. Health care operations include such activities as:
Underwriting, premium rating or related functions to create renewal, or to replace health insurance or health benefits.
- Quality assessment and improvement activities.
- Activities designed to improve health or reduce health care cost.
- Clinical guideline and protocol development or case management and care coordination.
- Accreditation, certification, licensing or credentialing activities.
- 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 coverage.
- Business management and general DHI administrative activities, including customer service and resolution of internal grievances.
Treatment Alternatives. 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.
Distributing 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
Required by Law. We may use and disclose your health information as required by any federal, state, or local law
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 to the Food and Drug Administration problems with products and reactions to medications; and (e) reporting disease or infection exposure.
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 overseeing the health care system
In Connection with Judicial and Administrative Proceedings. As permitted or required by state law, we may disclose your health information in the course of any administrative or judicial proceeding. This may be in response to the 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. We must make a reasonable effort either to notify you about the request or to obtain an order protecting your health information.
Law Enforcement. As permitted or required by state law, we may disclose your health information to a law enforcement official for certain law enforcement purposes including, but not limited to, suspicion that your death was a result of criminal conduct or in an emergency to report a crime.
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 a 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.
Specified Government Functions. In certain circumstances, federal regulations require us to use or disclose your health information to assist with government functions relating to military and veterans, national security and intelligence activities, protective services for the President and others, and correctional institutions and inmates.
When DHI 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. 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, though we will be unable to take back any disclosures we have already made with your permission.Statement of Your Health Information Rights
Right to Request Restrictions. You have the right to request restrictions on certain uses and disclosures of your health information. However, DHI 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.
Right to Request Confidential Communications. You have the right to request that DHI 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 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.
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.
Right to Request Amendment. You have a right to request that DHI amend health information that you believe is incorrect or incomplete. We are not required to change your health information. If your request is denied, we will provide you with information about our denial and how you can disagree with our 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.
Right to Accounting of Disclosures. Under the Privacy Rule, 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. Also, your accounting request should specify the time period of the information you want, but may not start earlier than April 14, 2003, and 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 at no charge. Subsequent accounting requests may require a reasonable fee. We will inform you in advance of any applicable fee.
Right to Paper Copy. You have a right to receive a paper copy of this Notice at any time. To obtain a paper copy of this Notice, send your written request to our 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 website, www.deancare.com.
Duties of Health Insurer/Prescription Drug Plan
We are required by law to maintain the privacy of your health information and this Notice will advise you of our duties and privacy practice requirements. We are also required to adhere to the terms of this Notice. DHI may amend this Notice at any time in the future, including adding new provisions concerning all the health information we maintain. When making material changes, we will promptly revise and distribute our Notice to you. Until then, DHI is required by law to comply with the current version of this Notice. Complaints about this Notice, or how we handle your health information, should be submitted in writing to our Privacy Officer. Please note that any complaint submitted to DHI will not be held against you in any way. In addition, if you believe your privacy rights have been violated, you may file a complaint with the Secretary of the United States 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 INSURANCE, INC.
1277 DEMING WAY
MADISON, WI 53717
1-800-279-1309
Privacy Notice PDP. 2005+
© 2005 Dean Health Insurance, Inc