Notice of Protected Health Information Privacy Practices
Reliance Standard Life Insurance Company
First Reliance Standard Life Insurance Company
Reliance Standard Life Insurance Company of Texas
We are required by law to maintain the privacy of our insured members’ and their
dependents’ personal health information and to provide notice of our legal
duties and privacy practices with respect to your personal health information.
We are required to abide by the terms of this Notice as long as it remains in
effect. We reserve the right to change the terms of this Notice as necessary and
to make the new Notice effective for all personal health information maintained
by us. Copies of revised Notices will be provided to you directly or to your
group’s Plan Sponsor (usually your employer) by regular mail or e-mail with
instructions to deliver a paper copy to each certificate holder.
CONTACT INFORMATION
In order to keep costs of your coverage down and provide you with the best
customer service, we may contract with outside carriers and/or vendors, known as
“business associates,” to assist us with the administration of your policy. For
example, we may contract with third party administrators who process claims and
collect premium payments; or paper-shredding companies who destroy records when
they are no longer needed. Because these business associates need access to your
protected health information in order to fulfill their obligations to us, we
require them to agree in writing to keep your protected health information
confidential in the same manner that we do as described in this Notice. Protected Health Information is: Any information that identifies you that we obtain from you or others that relates to your past, present or future healthcare including the payment for such healthcare. In the regular course of business we receive protected health information about you in order to provide you with our products and services. Some of this protected health information comes directly from you. For example, when you purchase one of our health insurance products for you and your family, you provide us with information about you and your covered dependents such as name, address, phone number, social security number, etc. Some of the protected health information we obtain about you comes from your provider. For example, as you and your covered dependents utilize your coverage, your healthcare provider sends us information about services and treatments performed so that we can process and pay your claims. All of this information we receive about you and your covered dependents is necessary in order for us to provide you and your covered dependents with quality health insurance products and to comply with legal requirements. HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
The following categories describe different ways we may use and disclose your
protected health information without your authorization. For each category of
uses and disclosures, we will explain what we mean and give an example. Not
every use or disclosure in a category will be listed. All of the ways we are
permitted to use and disclose information will fall within one of the identified
categories. For example, we may need to disclose your protected health information to a provider whom you have seen or are planning to see in order to pre-approve that a particular treatment you are seeking is covered under your plan. It is also necessary for us to use the information received from your medical provider concerning the services rendered to you so the health plan can pay the provider or reimburse you for the cost of the treatment under the terms of your plan. Finally, when you have more than one insurance policy that covers some of the same procedures as your plan with us, it may be necessary for us to exchange payment information with the carrier of your other insurance plan in order to coordinate the payment of your claim with that other carrier. For Health Care Operations: We may use and disclose protected health information about you and your covered dependents as necessary to operate your health insurance plan and promote quality service. For example, we may use or disclose your personal health information for quality assessment and quality improvement, credentialing health care providers, conducting or arranging for medical review or compliance. We may also disclose your personal health information to another health plan, health care facility or health care provider for activities such as quality assurance or case management. Business Associates: We may disclose protected health information to other persons or organizations, known as business associates, who provide services on our behalf under contract. However, in order to assure the protection your private information, we require our business associates to adhere to our Privacy Policies concerning the use and disclosure of your protected health information and appropriately safeguard the information we disclose to them. We prohibit our business associates from using and disclosing any of your protected health information in any manner except for the purpose intended by the contract. Business associates are expressly prohibited from using your protected health information to create any marketing target lists. Plan Sponsors: We may disclose your protected health information to your plan sponsor (usually your employer). It is our policy not to disclose your protected health information to your Plan’s sponsor.
There may by exceptional occasions
that your Plan Sponsor requests protected health information. We will only
disclose your protected health information to your Plan Sponsor if we have your
authorization to do so, or if the plan sponsor certifies that the information
will be maintained in a confidential manner and will not be utilized or
disclosed for employment-related actions and decisions or in connection with any
other benefit or employee benefit plan of the plan sponsor. We may use and disclose your protected health information for public policy purposes. For example: As Required By Law: We will disclose protected health information about you or your covered dependent when required to do so by federal, state or local law. For example, we may be required by law to disclose certain protected health information about you pursuant to a court order or subpoena served upon us. About Victims of Abuse, Neglect or Domestic Violence: For example, if we believe that you have been a victim of abuse, neglect or domestic violence, we may disclose your protected health information to the governmental entity or agency authorized to receive such information. In this case the disclosure will be made consistent with the requirements of applicable federal and state laws. Workers’ Compensation: We may release your protected health information for workers’ compensation or similar programs that provide benefits to you for work-related injuries or illness but only in a manner consistent with applicable laws.
Public Health: We may have an occasion to disclose protected health information
about you or your covered dependent for public health activities to a public
health authority that is permitted by law to collect or receive the information.
A public health activity would be, for example, an activity conducted by a
public health authority in the furtherance of preventing or controlling disease,
injury or disability; reporting births, deaths or reactions to medications; or
notifying people of recalls of products they may be using.
From time to time you may request that we disclose your protected health
information to other individuals or entities. For example, you may request that
we disclose your claims history to an attorney that you have hired to assist you
in a civil matter. Likewise, we may ask your permission to use or disclose your
protected health information. Any disclosures, such as these that do not fit
into one of the categories in the previous section require us to obtain your
written authorization prior to making such disclosure. In the event that you do
provide us with written authorization to use or disclose your information, you
may revoke such authorization at any time by writing to the Privacy Officer at
the address indicated in the “Contact” section of this Notice below. You have the following rights regarding protected health information that we maintain about you. All requests must be made in writing. Your Right to a Paper Copy of This Notice: You have the right to a paper copy of this Notice. You have a right to receive this Notice because you are insured by a health plan offered by Reliance Standard. You may ask us to give you a copy of this Notice at any time and we will comply. Even if you have agreed to receive this Notice electronically, you are entitled to a paper copy of this Notice if you so request. Your Right to an Accounting of Disclosures: You have the right to request a listing of any disclosures of your protected health information that we have made that are required by law. This listing would exclude disclosures we made to you, or pursuant to your authorization or request, or for payment of your claims as described above, or for health care operations as described above. Your request must state a time period that may not be longer than six years and may not include dates prior to April 14, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically, fax etc.). The first accounting of disclosures you request within a 12-month period will be free. We may charge for the costs of providing additional lists during that same 12-month period. In the event that you may incur a charge, we will notify you of the cost involved and you may choose to withdraw or modify your request before any costs are incurred. Your Right to Request an Amendment: You have the right to request an amendment to the protected health information that we maintain about you if you believe that our information is incorrect or incomplete. You maintain the right to request an amendment for as long as the information is kept by or for Reliance Standard. You must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. We may also deny your request if you ask us to amend information that: 1) was not created by us; 2) is not part of the medical information kept by or for Reliance Standard; 3) is not part of the information which you would be permitted to inspect and copy under the law; or 4) is accurate and complete. Your Right to Request a Restriction: You have the right to request a restriction or limitation on the protected health information we use or disclose about you for, payment or health plan operations. You also have the right to request a limit on the protected health information we disclose about you to someone who is involved in your care or the payment for care, like a family member or friend. We are not required to agree to your request. If we do agree to a requested restriction, we will comply with your request unless the information is needed to facilitate emergency treatment. To request restrictions, you must make your request in writing. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply. Your Right to Request Confidential Communications: You have the right to request that we communicate with you about payment for your medical matters in an alternative means (such as by fax) or at an alternative location (such as to your office). To request confidential communications, you must make your request in writing. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted. Your Rights to Inspect and Copy: You have the right to inspect and copy protected health information that we maintain about you that may be used to make decisions about payment for your care. To inspect this protected health information you may contact the Privacy Officer. To obtain copies of such protected health information, you must submit your request in writing as indicated below. If you request a copy of the information, 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 in certain very limited circumstances. If you are denied access to your protected health information, in most situations you may request that the denial be reviewed by a licensed health care professional who did not take part in the decision to deny access. We will comply with the outcome of the review. Your Right to Make Complaints: If you believe that your privacy rights have been violated you may make a complaint to the Privacy Office or to the Secretary of Health and Human Resources by writing to the Privacy Office or the Secretary of Health and Human Services, Office of Civil Rights as follows:
Any complaint you file will not cause you to suffer retaliation from our
company. We will promptly investigate your complaint as soon as we receive it.
When we have completed our investigation, we will notify you of our findings. If
the investigation reveals that your privacy rights have indeed been violated, we
will immediately take the appropriate measures to correct the violation pursuant
to our Privacy Practices and Procedures. |
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