UMWA Health and Retirement Funds’ 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.
The Funds is required by law to:
• Make sure that your protected health information is kept private;
• Give you this Notice about our legal duties and privacy practices with respect to your protected health information;
• Notify you following the breach of your unsecured protected health information; and
• Follow the terms of the Notice that is currently in effect.
I. HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
The Funds uses and discloses protected health information for many different reasons.
Below, we describe the different categories of our uses and disclosures and give you some examples of each category. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose protected health information will fall within one of the categories.
1. For Treatment. The Funds will use and disclose your protected health information as needed for professionals to treat you. For example, we may send your doctor information related to your participation in one of our programs so that your doctor can develop a treatment plan for you.
2. Payment. Your protected health information will be used or disclosed, as needed, to provide payment for your health care services. This may include determining your eligibility and coverage for health care services, reviewing services provided to you to determine if they were medically necessary, and performing utilization review activities, such as pre-approving services before you receive them.
For example, the Funds may review your eligibility information to determine what your Funds benefits are. We may use your protected health information to approve a hospital or nursing home stay. The Funds may also use your protected health information to obtain payment from responsible third parties.
3. Healthcare Operations. The Funds may use or disclose, as needed, your protected health information in order to support the business activities of the Funds’ health plans. For example, we may use your claims payment records to review the quality of our claims payment operations. We may also provide your claims payment information to our accountants, attorneys, consultants and others as necessary to make sure we are complying with the laws that affect us.
We may use or disclose your protected health information for underwriting purposes, but we are prohibited from using or disclosing any of your protected health information that is genetic information for underwriting purposes.
We may disclose your protected health information to the sponsor of your plan for the proper administration of the plan.
4. Business Associates. The Funds contracts with service providers – called business associates – to perform various functions on the Funds’ behalf. For example, the Funds may contract with a service provider to perform the administrative functions necessary to pay your medical claims. To perform these functions or to provide the services, business associates will receive, create, maintain, use or disclose protected health information but only after the Funds and the business associate agree in writing to contract terms requiring the business associate to appropriately safeguard your protected health information.
5. Other Covered Entities. The Funds may use or disclose your protected health information to assist health care providers in connection with their treatment or payment activities, or to assist other covered entities in connection with certain health care operations. For example, the Funds may disclose your protected health information to a health care provider when needed by the provider to render treatment to you, and the Funds may disclose protected health information to another covered entity to conduct health care operations in the areas of quality assurance and improvement activities, or accreditation, certification, licensing, or credentialing. This also means that the Funds may disclose or share your protected health information with other health care programs or insurance carriers (such as Medicare, etc.) in order to coordinate benefits, if you or your family members have other health insurance or coverage.
6. Health-Related Benefits and Services. We may use or disclose your protected health information to tell you about health-related benefits or services that may be of interest to you. For example, we may use your protected health information to inform you about flu shot clinics, transportation services such as van services, or health fairs. Your protected health information may be used to ensure that the proper medications are being prescribed, that emergency room visits are the appropriate level of care, and that nursing home care is medically necessary and should be utilized. We may also use your protected health information to determine if your medical conditions put you at risk for maintaining your health and independent living.
7. As Required by Law. We will use or disclose your protected health information when required to do so by federal, state or local law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures.
8. For Public Health Activities. We may use or disclose your protected health information for public health activities that are permitted or required by law. For example, we may notify the appropriate government authority to report child abuse or neglect.
9. For Health Oversight Activities. We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. These activities are necessary for the government to monitor the health care system, compliance with civil rights laws, and government programs such as Medicare. For example, we will provide information to assist the government when it conducts an investigation or inspection of a health care provider or organization. We may disclose your protected health information to assist government programs in their study and development of programs for senior citizens.
10. Lawsuits and Other Legal Proceedings. The Funds may disclose your protected health information in the course of any judicial or administrative proceeding or in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized). If certain conditions are met, the Funds may also disclose your protected health information in response to a subpoena, a discovery request, or other lawful process.
11. Abuse or Neglect. The Funds may disclose your protected health information to a government authority that is authorized by law to receive reports of abuse, neglect, or domestic violence. Additionally, as required by law, if the Funds believes you have been a victim of abuse, neglect, or domestic violence, it may disclose your protected health information to a governmental entity authorized to receive such information.
12. For Law Enforcement. We may disclose your protected health information for law enforcement purposes as required by law, in response to a court order or similar process, as necessary to locate or identify a suspect, fugitive, material witness or missing person, or in response to a law enforcement official’s request for information about an individual who is or is suspected of being a victim of a crime.
13. Coroners, Medical Examiners, and Funeral Directors. The Funds may disclose protected health information to a coroner or medical examiner when necessary for identifying a deceased person or determining a cause of death. The Funds may also disclose protected health information to funeral directors as necessary to carry out their duties.
14. Organ and Tissue Donation. The Funds may disclose protected health information to organizations that handle organ, eye, or tissue donation and transplantation.
15. Research. The Funds may use or disclose your protected health information for research when certain requirements are met.
16. To Individuals Involved in Your Care or Payment for Your Care. We may disclose your protected health information to a family member, other relative, friend, or any other person that you identify who is involved in your care or the payment for your health care, unless you object to such a disclosure or expressed your preference that we not do so before your death. We may also use or disclose your protected health information to notify or assist in notifying your family, personal representative or another person responsible for your care about your general condition, location, or death.
If you are unable to agree to or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment.
17. To the Funds’ Trustees. We may disclose your protected health information to the Funds’ Trustees as required to administer the Funds’ health plans.
18. To Avoid Harm. We may use or disclose your protected health information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure would only be to someone able to prevent the threat, such as law enforcement personnel. The Funds may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
19. Military. Under certain conditions, the Funds may use or disclose your protected health information if you are Armed Forces personnel for activities deemed necessary by appropriate military command authorities. If you are a member of foreign military service, the Funds may disclose, in certain circumstances, your information to the foreign military authority.
20. National Security and Protective Services. The Funds may disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, and for the protection of the President, other authorized persons, or heads of state.
21. Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, the Funds may disclose your protected health information to the correctional institution or to a law enforcement official for: (1) the institution to provide health care to you; (2) your health and safety, and the health and safety of others; or (3) the safety and security of the correctional institution.
22. For Disaster Relief Efforts. We may disclose your protected health information to an entity authorized by law or its charter to assist in disaster relief efforts to notify or assist in notifying your family, personal representative or another person responsible for your care about your general condition, location, or death.
23. For Workers’ Compensation Purposes. We may disclose your protected health information in order to comply with workers’ compensation laws and other similar programs that provide benefits for work-related injuries or illnesses.
24. To the Secretary of the U.S. Department of Health and Human Services. The Funds is required to disclose your protected health information to the Secretary of the U.S. Department of Health and Human Services when the Secretary is investigating or determining the Funds’ compliance with the HIPAA Privacy Rule.
25. To You. The Funds is required to disclose to you or your personal representative most of your protected health information when you request access to this information. The Funds will disclose your protected health information to an individual who has been designated by you as your personal representative and who has qualified for such designation in accordance with relevant law. Prior to such a disclosure, however, the Funds must be given written documentation that supports and establishes the basis for the personal representation. The Funds may not elect to treat the person as your personal representative if it has a reasonable belief that you have been, or may be, subject to domestic violence, abuse, or neglect by such person; treating such person as your personal representative could endanger you; or the Funds determines, in the exercise of its professional judgment, that it is not in your best interest to treat the person as your personal representative.
ALL OTHER USES AND DISCLOSURES REQUIRE YOUR PRIOR WRITTEN AUTHORIZATION
In any other situation not described above, we will ask for your written authorization before using or disclosing any of your protected health information and will only use or disclose your protected health information with your written authorization. We are generally required to obtain your authorization before we can use or disclose your psychotherapy notes. We are also required to obtain your authorization before using or disclosing your protected health information for marketing purposes or selling your protected health information. If you choose to sign an authorization to disclose your protected health information, you can revoke that authorization at any time in writing. This will stop any future uses and disclosures to the extent that we haven’t taken any action based on the authorization.
II. YOUR RIGHTS REGARDING YOUR HEALTH AND PAYMENT INFORMATION
You have the following rights:
A. The Right to See and Get Copies of Your Protected Health Information.
In most cases, you have the right to look at or get copies of your protected health information held by the Funds. You must request this information in writing. You may send your request to the Funds’ Privacy Officer at the address near the end of this Notice. We will respond within 30 days of receiving your request.
In certain situations, we may deny your request. If we do, we will tell you in writing our reasons for the denial and, if applicable, explain your right to have the denial reviewed.
B. The Right to Request Limits on the Uses and Disclosures of Your Protected Health Information for Healthcare Operations Purposes.
You have the right to ask that we limit how we use or disclose your protected health information for treatment, payment, or health care operations. Restrictions may include asking that we limit how we disclose your information to persons you identify. You may not limit the uses and disclosures that we are legally required to make.
You may send your written request to the address listed near the end of this Notice. Your written request must state the specific restriction requested and to whom you want the restriction to apply. We will consider your request, although we are not legally required to agree to it. We will try to comply with your wishes that do not impede our operations. If we accept your request, we will put any limits in writing and abide by them except in emergency situations.
C. The Right to Request Confidential Communications.
If you believe that a disclosure of all or part of your protected health information may endanger you, you may request that the Funds communicate with you in an alternative manner or at an alternative location. For example, you may ask that all communications be sent to your work address. You may request a confidential communication using the contact information near the end of this Notice. Your request must specify the alternative means or location for communication with you. It also must state that the disclosure of all or part of the protected health information in a manner inconsistent with your instructions would put you in danger. The Funds will accommodate a request for confidential communications that is reasonable and that states that the disclosure of all or part of your protected health information could endanger you.
D. The Right to Get a List of the Disclosures We Have Made
You have the right to get a list of instances in which we have disclosed your protected health information. The list will not include uses or disclosures made for treatment, payment or health care operations, those made directly to you, or those that you authorized. The list also will not include disclosures made for national security purposes, to corrections or law enforcement personnel, or before April 14, 2003.
You may send your request to the address listed near the end of this Notice. We will respond within 60 days of receiving your request. The list we will give you includes disclosures made in the last six years unless you request a shorter time. The list will include the date of disclosure, to whom the information was disclosed (including their address if known), a brief description of the information that was disclosed, and the reason for the disclosure. We will provide the list to you at no charge.
E. The Right to Correct or Update Your Protected Health Information.
If you believe that there is a mistake in your protected health information or that a piece of important information is missing, you have the right to request that we correct the existing information or add the missing information. You must provide the request and your reason for the request in writing. You may send your written request to the address listed near the end of this Notice. We will respond within 60 days of receiving your request.
We may deny your request in writing if the information is (i) correct and complete, (ii) not created by us (unless you provide us with a reasonable basis to believe that the originator of the information is no longer available to act on your request), (iii) not allowed to be disclosed to you or your personal representative, or (iv) not part of our records. Our written denial will state the reasons for the denial and explain your right to file a written statement of disagreement with the denial. If you do not file one, you have the right to request that your request and our denial be attached to all future disclosures of your protected health information.
If we approve your request, we will make the change to your information, tell you that we have done it, and tell others who need to know about the change.
F. The Right to Get This Notice by E-Mail or to Receive a Paper Copy of This Notice
You have the right to get a paper copy of this Notice, even if you have agreed to receive this Notice electronically. To obtain a paper copy of this Notice, please contact the Funds using the contact information below.
III. CHANGES TO THIS NOTICE
The Funds reserves the right to change the terms of this Notice and our privacy policies at any time. Any changes will apply to the information we already have as well as any information we receive in the future. The Funds will send a revised copy of this Notice to Funds' beneficiaries within sixty (60) days of any material change to this Notice.
IV. HOW TO EXERCISE YOUR RIGHTS
You may call the Funds’ Health Call Center at 1-800-291-1425 for assistance. The Health Call Center will help you determine when you need to file a written request and provide you with the correct form and instructions.
V. HOW TO COMPLAIN ABOUT OUR PRIVACY PRACTICES
If you think we have violated your privacy rights, or you disagree with a decision we made about access to your protected health information, you may file a complaint with the Funds’ Privacy Officer. You also may send a written complaint to the Secretary of the Department of Health and Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20201. We will take no retaliatory action against you if you file a complaint about our privacy practices.
VI. PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR TO COMPLAIN ABOUT OUR PRIVACY PRACTICES
If you have any questions about this Notice or any complaints about our privacy practices, contact the Funds’ Privacy Officer at:
UMWA Health & Retirement Funds
2121 K St., NW, Suite 350
Washington, D.C. 20037
You may also contact the Privacy Officer to find out how to file a complaint with the Secretary of the Department of Health and Human Services.
VII. EFFECTIVE DATE OF THIS NOTICE
This Notice went into effect on April 14, 2003. Revised September 19, 2013.