HIPAA JOINT PRIVACY NOTICE
THIS JOINT NOTICE DESCRIBES HOW MEDICAL
OTHER USES AND DISCLOSURES OF PHI
We may also use your PHI in the following ways:
INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS
INFORMATION. PLEASE REVIEW IT CAREFULLY.
•
To tell you about or recommend possible treatment alternatives
or other health-related benefits and services that may be of
interest to you.
INTRODUCTION
•
To your family or friends or any other individual identified by
you to the extent directly related to such person’s involvement
in your care or the payment for your care. We may use or
disclose your PHI to notify, or assist in the notification of, a
person responsible for your care, of your location, general
condition or death. If you are available, we will give you an
opportunity to object to these disclosures, and we will not make
these disclosures if you object.
This Joint Notice is being provided to you on behalf of LIBERTY
Dental Plan (the “Plan”) (collectively referred to herein as “We” or
“Our”). We understand that your medical information is private and
confidential. Further, we are required by law to maintain the privacy
of “protected health information.” or “PHI” which includes any
individually identifiable information that we obtain from you or
others that relates to your past, present or future physical or mental
health, the health care you have received, or payment for your health
care. We will share PHI as necessary, to carry out payment or health
care operations relating to the services to be rendered at the Plan
facilities.
•
When permitted by law, we may coordinate our uses and
disclosures of PHI with public or private entities authorized by
law or by charter to assist in disaster relief efforts.
•
•
We may disclose information to the sponsor of our plan.
As required by law, this notice provides you with information about
your rights and our legal duties and privacy practices with respect to
the privacy of PHI. This notice also discusses the uses and
disclosures we will make of your PHI. We must comply with the
provisions of this notice as currently in effect, although we reserve
the right to change the terms of this notice from time to time and to
make the revised notice effective for all PHI we maintain. You can
always request a written copy of our most current privacy notice
We may use your information for underwriting purposes;
however, we will not disclose genetic information for this
purpose.
•
•
We may contact you as part of our marketing efforts as
permitted by applicable law.
We will use or disclose PHI about you when required to do so
by applicable law.
Note: incidental uses and disclosures of PHI sometimes occur and
are not considered to be a violation of your rights. Incidental uses
and disclosures are by-products of otherwise permitted uses or
disclosures which are limited in nature and cannot be reasonably
prevented.
PERMITTED USES AND DISCLOSURES
We can use or disclose your PHI for purposes of treatment, payment
and health care operations. For each of these categories of uses and
disclosures, we have provided a description and an example below.
However, not every particular use or disclosure will be listed.
SPECIAL SITUATIONS
Subject to the requirements of applicable law, we will make the
following uses and disclosures of your PHI:
•
Treatment means the provision, coordination or management of
your health care, including consultations between health care
providers relating to your care and referrals for health care from
one health care provider to another. For example, we may
release information to a provider to coordinate your care.
•
•
Military and Veterans. If you are a member of the Armed
Forces, we may release PHI about you as required by military
command authorities. We may also release PHI about foreign
military personnel to the appropriate foreign military authority.
•
Payment means the activities we undertake to reimburse
providers for the health care provided to you, including billing,
collections, claims management, and other utilization review
activities. For example, we may need to obtain PHI from your
provider to determine whether the proposed course of treatment
will be covered or if necessary to obtain payment.
Public Health Activities. We may disclose PHI about you for
public health activities, including disclosures:
*
*
*
*
to prevent or control disease, injury or disability;
to report births and deaths;
to report child abuse or neglect;
to persons subject to the jurisdiction of the Food and
Drug Administration (FDA) for activities related to the
quality, safety, or effectiveness of FDA-regulated
products or services and to report reactions to
medications or problems with products;
•
Health care operations means the support functions of the Plan,
related to treatment and payment, such as quality assurance
activities, case management, responding to patient complaints,
compliance programs, audits, business planning, development,
management and administrative activities. For example we
may combine PHI about many patients to decide what
additional services we should offer. In addition, we may
remove information that identifies you so that others can use
the de-identified information to study health care and health
care delivery without learning who you are.
*
*
to notify a person who may have been exposed to a
disease or may be at risk for contracting or spreading a
disease or condition;
to notify the appropriate government authority if we
believe that an adult patient has been the victim of
abuse, neglect or domestic violence. We will only make
1
4
027973v.1
