HIPAA PRIVACY PRACTICES
USE AND
DISCLOSURE OF HEALTH INFORMATION
The
Fund may use your health information, that is, information that
constitutes “protected health information” as defined in the Privacy Rule of the
Administrative Simplification provision of the Health Insurance Portability and
Accountability Act of 1996 ("HIPAA"), for purposes of making or obtaining
payment for your care and conducting health care operations. The Fund has
established a policy to guard against unnecessary disclosure of your health
information. Please note that, under the Privacy Rule, “protected health
information” does not include information relating to weekly disability or life
insurance benefits.
IN ADDITION TO OTHER USES AND DISCLOSURES PERMITTED UNDER
HIPAA, THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES
FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED:
To Make or Obtain Payment.
The Fund may use or disclose your health information to make payment to or
collect payment from third parties, such as other trust funds, health plans or
providers, for the care you receive. For example, the Fund may provide
information regarding your coverage or health care treatment to other the Funds
to coordinate payment of benefits.
To Conduct Health Care Operations.
The Fund may use or disclose health information for its own operations to
facilitate the administration of the Fund and as necessary to provide coverage
and services to all of the Fund's participants. Health care operations includes
such activities as:
- Quality
assessment and improvement activities.
- Member Service
activities relating to claim eligibility and payment. Benefit eligibility of a
family member may be disclosed to the Member or spouse (or, in the case of a
non-mentally handicapped dependent child over the age of 18, to that dependent
child). Limited information (such as whether a claim has been received or paid)
regarding your claims may be disclosed, upon appropriate authentication, to your
spouse, unless you advise us that no information should be released to your
spouse except upon an express written authorization. Claims information relating
to dependent children under the age of 18 may be disclosed to the parent or
legal guardian of that child. Claims information relating to covered dependents
over the age of 18 may be disclosed only to that dependent, unless the dependent
authorizes the disclosure of claims information to someone else, including the
parent or legal guardian of that dependent. Claims information relating to a
mentally handicapped dependent child over the age of 18 may be disclosed to the
parent or legal guardian of that child.
- Activities
designed to improve health or reduce health care costs.
- Clinical
guideline and protocol development, case management and care coordination.
- Contacting health
care providers and participants with information about treatment alternatives
and other related functions.
- Health care
professional competence or qualifications review and performance evaluation.
- Accreditation,
certification, licensing or credentialing activities.
- Underwriting,
premium rating or related functions to create, renew or replace health insurance
or health benefits.
- Review and
auditing, including compliance reviews, medical reviews, legal services and
compliance programs.
- Business planning
and development including cost management and planning related analyses and
formulary development.
- Business
management and general administrative activities of the Fund, including customer
service and resolution of internal grievances.
For example, The Fund may use your health
information to conduct case management, quality improvement and utilization
review, and provider credentialing activities or to engage in customer service
and grievance resolution activities.
For Treatment Alternatives. The Fund may use and
disclose your health information to Fund consultants to tell you about or
recommend possible treatment options or alternatives that may be of interest to
you.
For Distribution of
Health-Related Benefits and Services.
The Fund may use or disclose
your health information to provide to you information on health-related benefits
and services that may be of interest to you.
For Disclosure to the Plan Sponsor. The Fund may
disclose your health information to the plan sponsor (the Fund’s Board of
Trustees) for plan administration functions performed by the plan sponsor on
behalf of the Fund. The Fund also may provide summary health information to the
plan sponsor so that the plan sponsor may solicit premium bids from other the
Funds or modify, amend or terminate the plan.
When Legally Required. The Fund will disclose your
health information when it is required to do so by any federal, state or local
law.
To Conduct Health Oversight Activities.
The Fund may disclose your health information to a health oversight agency for
authorized activities including audits, civil administrative or criminal
investigations, inspections, licensure or disciplinary action. The Fund,
however, may not disclose your health information if you are the subject of an
investigation and the investigation does not arise out of or is not directly
related to your receipt of health care or public benefits.
In Connection With Judicial and Administrative Proceedings.
As permitted or required by state law, the Fund may disclose your health
information in the course of any judicial or administrative proceeding 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, but only when the Fund makes reasonable efforts to either
notify you about the request or to obtain an order protecting your health
information.
For Law Enforcement Purposes.
As permitted or required by state law, the Fund may disclose your health
information to a law enforcement official for certain law enforcement purposes,
including, but not limited to, if the Fund has a suspicion that your death was
the result of criminal conduct or in an emergency to report a crime.
In the Event of a Serious Threat to Health or Safety.
The Fund may, consistent with applicable law and ethical standards of conduct,
disclose your health information if the Fund, in good faith, believes 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.
For Specified Government Functions.
In certain circumstances, federal regulations require the Fund use or disclose
your health information to facilitate specified government functions related to
the military and veterans, national security and intelligence activities,
protective services for the President and others, and correctional institutions
and inmates.
For Worker's Compensation.
The Fund may release your health information to the extent necessary to comply
with laws related to worker's compensation or similar programs.
AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION
Other than as stated above, the Fund will not
disclose your health information other than upon your written authorization. An
authorization must contain certain language and, for that reason, the Fund has
developed an appropriate form that is available in the Fund office or on the
Fund’s web site. Such authorizations are limited by the event (such as a claim)
and by time. Blanket authorizations for general disclosures are not permitted
under HIPAA’s Privacy Rule. If you authorize the Fund to use or disclose your
health information, you may revoke that authorization in writing at any time.
YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
You have the following rights regarding your health
information that The Fund maintains:
Right to Request Restrictions.
You may request restrictions on certain uses and disclosures of your health
information. You have the right to request a limit on the Fund's disclosure of
your health information to someone involved in the payment of your care.
However, the Fund is not required to agree to your request. If you wish to make
a request for restrictions, please contact the Fund’s Privacy Officer whose name
and address appears at the end of this Notice.
Right to Receive Confidential Communications.
You have the right to request that the Fund 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 the Fund only communicate with you at a certain
telephone number or by email. If you wish to receive confidential
communications, please make your request in writing to Fund’s Privacy Officer
whose name and address appears at the end of this Notice. The Fund will
attempt to honor your reasonable requests for confidential communications.
Right to Inspect and Copy Your Health Information.
You have the right to inspect and copy your health information. A request to
inspect and copy records containing your health information must be made in
writing to Fund’s Privacy Officer whose name and address appears at the end of
this Notice. If you request a copy of your health information, the Fund
may charge a reasonable fee for copying, assembling costs and postage, if
applicable, associated with your request.
Right to Amend Your Health
Information. If you
believe that your health information records are inaccurate or incomplete, you
may request that the Fund amend the records. That request may be made as long
as the information is maintained by the Fund. A request for an amendment of
records must be made in writing to Fund’s Privacy Officer whose name and address
appears at the end of this Notice. The Fund may deny the request if it does not
include a reason to support the amendment. The request also may be denied if
your health information records were not created by the Fund, if the health
information you are requesting to amend is not part of the Fund's records, if
the health information you wish to amend falls within an exception to the health
information you are permitted to inspect and copy, or if the Fund determines the
records containing your health information are accurate and complete.
Right to an Accounting. You have the right to request a list of disclosures
of your health information made by the Fund for any reason other than for (1)
treatment, payment or health care operations, (2) disclosures made under
circumstances described in this Notice, or (3) disclosures which you
authorized. The request must be made in writing to Fund’s Privacy Officer whose
name and address appears at the end of this Notice. The request should
specify the time period for which you are requesting the information, but may
not start earlier than April 14, 2003. Accounting requests may not be made for
periods of time going back more than six (6) years. The Fund 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.
The Fund will inform you in advance of the fee, if applicable.
Right to a Paper Copy of this Notice.
You have a right to request and receive a paper copy of this Notice at any time,
even if you have received this Notice previously or agreed to receive the Notice
electronically. To obtain a paper copy, please contact Fund’s Privacy Officer
whose name and address appears at the end of this Notice. You also may
obtain a copy of the current version of the Fund's Notice at its web site,
www.teamsterfunds.com.
DUTIES OF THE FUND
The Fund is required by law to maintain the
privacy of your health information as set forth herein and to provide to you a
Notice of its duties and privacy practices. The Fund is required to abide by
the terms of this Privacy Policy, which may be amended from time to time. The
Fund reserves the right to change the terms of this Privacy Policy and to make
the new Policy provisions effective for all health information that it
maintains. If the Fund changes its policies and procedures, the Fund will
revise the Notice of Privacy Practices and will provide a copy of the revised
Notice to you within 60 days of the change. You have the right to express
complaints to the Fund and to the Secretary of the Department of Health and
Human Services if you believe that your privacy rights have been violated. Any
complaints to the Fund should be made in writing to Fund’s Privacy Officer whose
name and address appears at the end of this Section. The Fund encourages
you to express any concerns you may have regarding the privacy of your
information. You will not be retaliated against in any way for filing a
complaint.
CONTACT PERSON
The Fund has designated William J. Einhorn, the
Fund’s Administrator as its contact person for all issues regarding patient
privacy and your privacy rights. You may contact this person at the following:
Privacy Officer
Teamsters Health & Welfare Fund of Philadelphia and Vicinit
4th & Cherry Streets
Philadelphia, PA 19106
(215) 923-6300 ext. 1170
(fax) (215) 931-1132
IF
YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT THE PRIVACY OFFICER
IDENTIFIED ABOVE.
Health
& We
lfare
and Pension Funds