Privacy Notices

The Health Insurance and Accountability Act (HIPAA) Privacy Rule affords members the right to receive a notice that describes how health information may be used and disclosed and how to get access to this information.

Notice of Privacy Practices Effective Date September 23, 2013.

Notice of 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.

This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out payment, treatment, and health care operations, and for other purposes that are permitted or required by law. It also sets out our legal obligations concerning your protected health information. Additionally, this Notice describes your rights to access and control your protected health information.

Protected health information is individually identifiable health information, including demographic information, collected from you or created or received by a health care provider, a health plan, your employer, or a health care clearinghouse and that relates to: (i) your past, present, or future physical or mental health or condition; (ii) the provision of health care to you; or (iii) the past, present, or future payment for the provision of health care to you.

If you have any questions or want additional information about the Notice or the policies and procedures described in the Notice, please contact: Privacy Official, Allegian Health Plans, 2005 Ed Carey Drive, Harlingen, Texas 78550, 1-855-381-3442 or fax 1-855-381-3443.

Effective Date

This notice is effective on September 23, 2013.

We Have a Legal Duty to Safeguard Your Protected Health Information

We are required by law to maintain the privacy of your protected health information. We are obligated to provide you with a copy of this Notice of our legal duties and our privacy practices with respect to protected health information. And we must abide by the terms of this Notice. We reserve the right to change the provisions of our Notice and make the new provisions effective for all protected health information that we maintain. If we make a material change to our Notice, we will mail a revised Notice to the address that we have on record for you.

How We May Use and Disclose Your Protected Health Information

The following is a description of how we are most likely to use and/or disclose your protected health information. Where state law provides additional restrictions on how we can use and disclose information, we will follow applicable state laws.

Payment. We may use or disclose your protected health information to obtain premiums, to determine cost share, or otherwise fulfill our responsibilities established under your member contract. For example, we may disclose your protected health information when a provider requests information regarding your eligibility for coverage under our health plan.

Treatment. While we do not provide medical treatment, we may use your protected health information to assist health care providers in coordinating or arranging medical treatment or services for you.

Health Care Operations. We may use or disclose your protected health information to support our business functions. For example, we may use your information to conduct audits or medical review of claims activity.

Business Associates. We contract with individuals and entities (known as "business associates") to perform various functions on our behalf or to provide certain types of services. Some of the functions they provide are administering claims, member services support, utilization management, subrogation, and pharmacy benefit management. To perform these functions or to provide the services, business associates may receive, create, maintain, use, or disclose protected health information, but only after we require the business associates to agree in writing to contract terms designed to appropriately safeguard your information.

Health Oversight Activities. We may disclose your protected health information to a health oversight agency for activities authorized by law, such as audits; investigations; inspections; and licensure or disciplinary actions.

Required by Law or Legal Proceeding. We may use or disclose your protected health information to the extent that federal, state, or local law requires the use or disclosure. For example, we make disclosures when the law requires that we report information to a government agency or law enforcement personnel. We may also disclose your protected health information in response to a subpoena, regulatory inquiry or audit.

Health Promotion and Disease Prevention. We may use your protected health information to tell you about disease prevention and health care programs. For example, we may send you information about diabetes and asthma programs. Your health plan may also work with other agencies on good health and disease prevention programs. However, it must obtain written permission (a Privacy Authorization) from you if it receives payment from a third party (for example, a supplier or breathing machines or a doctor who does a special medical procedure) to make these communications to you, unless permission is given in a face to face meeting.

Plan Sponsor. If you are covered under a group health plan or HMO, we may disclose your protected health information to the sponsor of your health plan.

Workers' Compensation. We may disclose your protected health information to comply with workers' compensation laws and other similar programs that provide benefits for work-related injuries or illnesses.

Marketing Purposes. Your health plan is required to obtain authorization from you when it receives payment for making communications from a third party whose product or service is being marketed to you. This does not apply to programs that your health plan promotes as its own program to encourage you to live healthier, e.g. a disease management program.

Underwriting. Your health plan cannot use or disclose genetic information for underwriting purposes.

Others Involved in Your Health Care. Unless you object, we may disclose your protected health information to a friend or family member that you have identified as being involved in your health care. If you are not present or able to agree to these disclosures of your protected health information, then we may, using our professional judgment, determine whether the disclosure is in your best interest.

Other Uses and Disclosures of Your Protected Health Information

Other uses and disclosures of your protected health information that are not described above, and not otherwise permitted, will be made only with your written authorization. If you provide us with such an authorization, you may revoke the authorization in writing, and this revocation will be effective for future uses and disclosures of protected health information. However, the revocation will not be effective for information that we already have used or disclosed in reliance on your authorization.

Your Rights Regarding Your Protected Health Information

The following is a description of your rights with respect to your protected health information.

Right to Request a Restriction. You have the right to request a restriction on the protected health information we use or disclose about you. You also have the right to request a limit on your health information that we disclose to someone involved in your care or the payment for your care. You do not have the right to request restrictions for giving out your information when we are asked to do so by law enforcement officials or court officials. Your health plan is not required to agree to your request for a restriction unless you are asking us to restrict the use and disclosure of your health information for payment or heath care operations purposes and the health information you wish to restrict pertains solely to a health care item or service for which you have paid for yourself “out-of-pocket” in full. If your health plan agrees, it will comply with your request unless the information is needed to provide you with emergency treatment. You may request a restriction by writing. In your request tell us: (1) the information whose disclosure you want to limit and (2) how you want to limit our use and/or disclosure of the information.

Right to Request Confidential Communications. If you believe that a disclosure of your protected health information may endanger you, you may request that we communicate with you regarding your information in an alternative manner or at an alternative location. For example, you can ask that we only contact you at your work address or via your work e-mail. You may request a restriction by writing. In your request tell us: (1) the parts of your protected health information that you want us to communicate with you in an alternative manner or at an alternative location and (2) that the disclosure of all or part of the information in a manner inconsistent with your instructions would put you in danger.

Right to Inspect and Copy. In most cases, you have the right to inspect and copy your protected health information that is contained in a "designated record set". Generally, a "designated record set" contains medical and billing records, as well as other records that are used to make decisions about your health care benefits. To inspect and copy your protected health information that is contained in a designated record set, you must submit your request in writing. We may charge a fee for the costs of copying, mailing, or other supplies associated with your request. We may deny your request to inspect and copy your protected health information in certain circumstances. If you are denied access to your information, we will inform you, in writing, our reasons for the denial and explain your right to have the denial reviewed.

Right to Amend. If you believe that your protected health information is incorrect or incomplete, you may request that we amend your information. You may request that we amend your information by writing, and should include the reason the amendment is necessary. In certain cases, we may deny your request for an amendment. For example, we may deny your request if the information you want to amend is not maintained by us, but by another entity. If we deny your request, you have the right to file a statement of disagreement with us. Your statement of disagreement will be linked with the disputed information and all future disclosures of the disputed information will include your statement.

Right to an Accounting. You have a right to an accounting of most disclosures of your protected health information that are for reasons other than payment, treatment, or health care operations. An accounting will include the date(s) of the disclosure, to whom we made the disclosure, a brief description of the information disclosed, and the purpose for the disclosure. You may request an accounting by submitting your request in writing. Your request may be for disclosures made up to 6 years before the date of your request, but in no event, for disclosures made before April 14, 2003. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at the time before any costs are incurred.

Right to be notified of a breach. You have a right to be notified when your Protected Health Information (PHI) has been compromised, meaning exposed to a person or company who received it by mistake. You will be notified within 60 days of such breach.

Restriction on Sale of Protected Health Information. Your health plan cannot sell your Protected Health Information (PHI) without your permission. Your health plan currently does not sell your PHI and from now on we cannot sell it without your authorization.

Disclosures of Student Immunization. Your health plan may request permission from you, which may be verbal, to release immunization records (shots to prevent medical conditions for your child) to schools.

Fundraising Activities. Your health plan is permitted to send you materials related to fundraising activities. You may always opt out of receiving such documents. Any fundraising materials you receive will tell you how to opt out.

Any other uses and disclosures not outlined in this Notice of Privacy Practices will only be made with permission from you.

Right to This Notice. You have the right to receive a copy of this Notice by e-mail. You have the right to a paper copy of this Notice, even if you have agreed to accept this Notice electronically.

To fulfill any of the above requests in writing, send the description of your request to: Privacy Official, Allegian Health Plans, 1596 Whitehall Road, Annapolis, MD 21409. 855-381-3442 or fax 855-381-3443.

How to Complain About Privacy Practices

You may complain to us if you believe that we have violated your privacy rights. You may file a complaint with us by writing to: Privacy Official, Allegian Health Plans, 2005 Ed Carey Drive, Harlingen, Texas 78550.

You also may file a complaint with the Secretary of the U.S. Department of Health and Human Services. Complaints filed directly with the Secretary must: (1) be in writing; (2) contain the name of the entity against which the complaint is lodged; (3) describe the relevant problems; and (4) be filed within 180 days of the time you became or should have become aware of the problem.

We will not retaliate against you for filing a complaint with the Secretary or with us, meaning that you will not lose your health plan membership or health care benefits if you file a complaint.

Visit your member portal to look up benefits, check your claim status, and much more.

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Allegian Health Plans, 4801 NW Loop 410 Ste. 300, San Antonio, TX 78229

Main Number (855) 381-3442
TRS-ActiveCare Members (855) 463-7264