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.

Protected Health Information

In its normal course of business, the Fund receives, uses and discloses personal health information about you and your eligible dependents, if any. The purpose of this notice is to inform you of how the Fund receives and protects your personal health information as well as under what circumstances the Fund uses and discloses that information. It should be noted that the Fund is required to protect your health information as well as provide you with a notice of the Fund's privacy policies and procedures with regard to your personal health information. The Fund is required to abide by the terms of this notice. The Fund will continue to comply with the privacy policy in order to protect your personal health information. The Fund will not change these policies unless you are given notice of the change.

 Uses and Disclosures:

The Suffolk County Municipal Employees Benefit Fund from time to time uses and discloses your personal health information. Most of the time those uses and disclosures of your personal health information fall under a category of use (and disclosure) known as treatment, payment and health care operations (TPO). It is acceptable for the Fund, and certain other entities, to use and/or disclose your personal heath information without your prior authorization provided it falls into one of the allowable reasons. The types of uses and disclosure that fall under this category are as follows: 

1.       The use of your PHI by a direct treatment provider who is treating you; or

2.       The disclosure of your PHI by a provider to your health plan; or

3.       The disclosure of your PHI by your health plan when processing a claim for payment; or

4.       The use of your PHI for health care operations. 

Examples:

Example #1: Use of your PHI by a provider who is treating you:

You are in a hospital receiving medical care. The primary physician treating you wants the opinion of another Doctor on staff. The primary Doctor reviews and discusses your case with the other Doctor. The primary Doctor is both using and disclosing your personal health information (PHI) to someone. However, this is an allowable use and disclosure of your PHI.

Example #2: Disclosure of your PHI by a provider to your health plan:

You receive medical care from a Doctor, Hospital, Laboratory or other medical provider. The provider then bills your Health/Welfare Plan. In this case your provider is disclosing personal health information (PHI) about you to another entity. However, it is being done with the intention of processing the claim for payment and, as such, this is an allowable release of PHI. This also applies if a medical provider is checking to see if a procedure is covered by the Plan. 

Example #3: Disclosure of your PHI by your health plan when processing a claim for payment

You receive medical care from a Doctor, Hospital, Laboratory or other medical provider. The provider then bills your Health/Welfare Plan. When your Health Plan receives the information, they realize that it is an incomplete claim. In order to process it for payment they need to contact the provider to receive more information. In order for the Provider's office to identify who the patient is and the correct claim, the Health Plan must give the provider certain information to allow them to identify the claim. This is an allowable disclosure of PHI. 

In this case your provider is disclosing personal health information (PHI) about you to another entity. However, it is being done with the intention of processing the claim for payment and, as such, this is an allowable release of PHI. 

Other Uses and Disclosures:

There are other uses and disclosures of your personal health information that may occur without your authorization. Following is a description of these: 

1.       A disclosure pursuant to a court order

2.       A disclosure in response to a requirement of the government

3.       To detect or prevent fraud

4.       To review the Fund's utilization

5.       To conduct an audit of the claims and/or the claims operations

6.       To conduct an actuarial study 

Authorization Regarding Uses and/or Disclosures of Personal Health Information:

From time to time there may arise the need for the Fund to seek your authorization before disclosing your Personal Health Information. Before a release of your personal health information occurs outside of the allowable reasons, the Fund will need to obtain your written authorization. 

Please note the following with regard to your ability to revoke the authorization. 

Right to Revoke ‑ you have a right to revoke this authorization at any time in writing. There are two exceptions as follows:

a.       If the information you authorized to be released has already been released.

b.       If your authorization was required as a condition of obtaining the coverage. 

Procedure to Revoke ‑ To revoke this authorization you may either complete a new authorization form stating someone else is authorized or that no one is authorized to use and/or disclosure your PHI. Alternatively, you may submit a letter stating your intentions to revoke this authorization. In either case the revocation must be in writing, an original document and signed by you. 

More Stringent Standard

When comparing this law to the State Law if the State Law restricts the use and/or disclosure of personal health information in an area not restricted under HIPAA, then the Plan must abide by the State Law and restrict the disclosure of PHI in those cases. There are two exceptions to this as follows: 

1.   If the PHI is required to be released by the Secretary in order to verify that that the Health Plan is in compliance with the law and

2.   The information may be released to the individual who is the subject of the PHI. 

Your Rights:

You have the right to request in writing to inspect and copy your personal heath information. You also have the right to request that the Fund amend any information about you that may be incorrect. You may also request that the Fund restrict uses and/or disclosures of your personal health information. The Fund has a right to deny your request for a restriction. You also have a right to receive communications of personal health information by alternative means or at alternative locations. You have the right to receive certain disclosures of personal health information provided they fall outside of the allowable reasons.

Updated 02/24/2003