When the
Disclosure of Your PHI Requires Your Written Authorization
The Plan must generally obtain your
written authorization before the Plan will use or disclose
psychotherapy notes about you from your psychotherapist. However,
the Plan may use and disclose such notes when needed by the Plan
to defend itself against litigation filed by you.
Use or Disclosure
of Your PHI That Requires You Be Given an Opportunity to Agree or
Disagree Before the Use or Release
Disclosure of your PHI to family
members, other relatives and your close personal friends is
allowed under federal law if:
·
The information is
directly relevant to the family or friend’s involvement with your
care or payment for that care, and
·
You have either agreed
to the disclosure or have been given an opportunity to object and
have not objected.
Use or Disclosure
of Your PHI For Which Consent, Authorization or Opportunity to
Object Is Not Required
The Plan is allowed under federal law
to use and disclose your PHI without your consent, authorization
or request under the following circumstances:
1.
When required by
law.
2.
Public health
purposes. To an authorized public health official if
required by law or for public health and safety purposes. PHI may
also be used or disclosed if you have been exposed to a
communicable disease or are at risk of spreading a disease or
condition, if authorized by law.
3.
Domestic violence
or abuse situations. When authorized by law to report
information about abuse, neglect or domestic violence to public
authorities if a reasonable belief exists that you may be a victim
of abuse, neglect or domestic violence. In such case, the Plan
will promptly inform you that such a disclosure has been or will
be made unless that notice would cause a risk of serious harm.
4.
Oversight
activities. To a public health oversight agency for
oversight activities authorized by law. These activities include
civil, administrative or criminal investigations, inspections,
licensure or disciplinary actions (for example, to investigate
complaints against providers) and other activities necessary for
appropriate oversight of government benefit programs (for example,
to the Department of Labor).
5.
Legal proceedings.
When required for judicial or administrative proceedings.
For example, your PHI may be disclosed in response to a subpoena
or discovery request that is accompanied by a court order.
6.
Law enforcement
health purposes. When required for law enforcement
purposes (for example, to report certain types of wounds).
7.
Law enforcement
emergency purposes. For certain law enforcement purposes,
including:
a.
identifying or locating
a suspect, fugitive, material witness or missing person, and
b.
disclosing information
about an individual who is or is suspected to be a victim of a
crime, but only if the individual agrees to the disclosure or the
covered entity is unable to obtain the individual’s agreement
because of emergency circumstances.
8.
Determining cause
of death and organ donation. When required to be given to
a coroner or medical examiner to identify a deceased person,
determine a cause of death or other authorized duties. The Plan
may also disclose PHI for cadaveric organ, eye or tissue donation
purposes.
9.
Funeral purposes.
When required to be given to funeral directors to carry
out their duties with respect to the decedent.
10.
Research.
For research, subject to certain conditions.
11.
Health or safety
threats. When, consistent with applicable law and
standards of ethical conduct, the Plan in good faith believes the
use or disclosure is necessary to prevent or lessen a serious and
imminent threat to the health or safety of a person or the public
and the disclosure is to a person reasonably able to prevent or
lessen the threat, including the target of the threat.
12.
Workers’
compensation programs. When authorized by and to the
extent necessary to comply with workers’ compensation or other
similar programs established by law.
Except as otherwise indicated in this
notice, uses and disclosures will be made only with your written
authorization subject to your right to revoke your authorization.
Other Uses or
Disclosures
The Plan may contact you to provide
you information about treatment alternatives or other
health-related benefits and services that may be of interest to
you.
The Plan may disclose protected health
information to the sponsor of the Plan for reviewing your appeal
of a benefit claims or for other reasons regarding the
administration of this Plan. The “Plan sponsor” of this Plan is
the Fox Valley Laborers Health and Welfare Fund Board of Trustees.
Section 3: Your Individual Privacy Rights
You May Request
Restrictions on PHI Uses and Disclosures and Receipt of PHI
You may request the Plan to:
1.
Restrict the uses and
disclosures of your PHI to carry out treatment, payment or health
care operations, or
2.
Restrict uses and
disclosures to family members, relatives, friends or other persons
identified by you who are involved in your care.
The Plan, however, is not required to
agree to your request if the Fund Administrator or Privacy
Official determines it to be unreasonable.
In addition, the Plan will accommodate
an individual’s reasonable request to receive communications of
PHI by alternative means or at alternative locations where
the request includes a statement that disclosure could endanger
the individual.
You or your personal representative
will be required to complete a form to request restrictions on
uses and disclosures of your PHI or to receive communications of
PHI by alternative means or at alternative locations. Make such
requests to:
Administrative Manager
Fox Valley Laborers Health and Welfare
Fund
2400 Big Timber Road
Building B, Suite 206
Elgin, Illinois 60124-8810
You May Inspect
and Copy PHI
You have a right to inspect and obtain
a copy of your PHI
contained in a “designated record
set,” for as long as the Plan maintains the PHI.
The Plan must provide the requested
information within 30 days if the information is maintained on
site or within 60 days if the information is maintained offsite. A
single 30-day extension is allowed if the Plan is unable to comply
with the deadline.
You or your personal representative
will be required to complete a form to request access to the PHI
in your designated record set. Requests for access to PHI should
be made to the following officer:
Administrative Manager
Fox Valley Laborers Health and Welfare
Fund
2400 Big Timber Road
Building B, Suite 206
Elgin, Illinois 60124-8810
If access is denied, you or your
personal representative will be provided with a written denial
setting forth the basis for the denial, a description of how you
may exercise your review rights and a description of how you may
complain to Plan and the Secretary of the U.S. Department of
Health and Human Services.
You Have the Right
to Amend Your PHI
You have the right to make a written
request that the Plan amend your PHI or a record about you in a
designated record set for as long as the PHI is maintained in the
designated record set subject to certain exceptions. See the
Plan’s Right to Amend Policy for a list of exceptions.
The Plan has 60 days after receiving
your request to act on it. The Plan is allowed a single 30-day
extension if the Plan is unable to comply with the 60-day
deadline. If the Plan denied your request in whole or part, the
Plan must provide you with a written denial that explains the
basis for the decision. You or your personal representative may
then submit a written statement disagreeing with the denial and
have that statement included with any future disclosures of that
PHI.
You should make your written request
to amend PHI to the following officer:
Administrative Manager
Fox Valley Laborers Health and Welfare
Fund
2400 Big Timber Road
Building B, Suite 206
Elgin, Illinois 60124-8810
You or your personal representative
will be required to complete a form to request amendment of the
PHI.
You Have the Right
to Receive an Accounting of the Plan’s PHI Disclosures
At your request, the Plan will also
provide you with an accounting of disclosures by the Plan of your
PHI. The Plan does not have to provide you with an accounting of
disclosures related to treatment, payment or health care
operations or disclosures made to you or authorized by you in
writing. See the Plan’s Accounting for Disclosure Policy for the
complete list of disclosures for which an accounting is not
required.
The Plan has 60 days to provide the
accounting. The Plan is allowed an additional 30 days if the Plan
gives you a written statement of the reasons for the delay and the
date by which the accounting will be provided.
If you request more than one
accounting within a 12-month period, the Plan will charge a
reasonable, cost-based fee for each subsequent accounting.
Your Personal
Representative
You may exercise your rights through a
personal representative. Your personal representative will be
required to produce evidence of authority to act on your behalf
before the personal representative will be given access to your
PHI or be allowed to take any action for you. Proof of such
authority will be a completed, signed and approved Appointment of
Personal Representative form. You may obtain this form by calling
the Fund Office.
The Plan retains discretion to deny
access to your PHI to a personal representative to provide
protection to those vulnerable people who depend on others to
exercise their rights under these rules and who may be subject to
abuse or neglect.
The Plan will recognize certain
individuals as personal representatives without you having to
complete an Appointment of Personal Representative form. For
example, the Plan will automatically consider a spouse to be the
personal representative of an individual covered by the Plan. In
addition, the Plan will consider a parent or guardian as the
personal representative of an unemancipated minor unless
applicable law requires otherwise. A spouse or a parent may act on
an individual’s behalf, including requesting access to their PHI.
Spouses and unemancipated minors may, however, request that the
Plan restrict information that goes to family members as described
above at the beginning of Section 3 of this Notice.
You should also review the Plan’s
Policy and Procedure for the Recognition of Personal
Representatives for a more complete description of the
circumstances where the Plan will automatically consider an
individual to be a personal representative.
Section 4: The
Plan’s Duties
Maintaining Your
Privacy
The Plan is required by law to
maintain the privacy of your PHI and to provide you and your
eligible dependents with notice of its legal duties and privacy
practices.
This notice is effective beginning on
April 14, 2003 and the Plan is required to comply with the terms
of this notice. However, the Plan reserves the right to change its
privacy practices and to apply the changes to any PHI received or
maintained by the Plan prior to that date. If a privacy practice
is changed, a revised version of this notice will be mailed to you
and to all past and present participants and beneficiaries for
whom the Plan still maintains PHI.
Any revised version of this notice
will be distributed within 60 days of the effective date of any
material change to:
·
The uses or disclosures
of PHI,
·
Your individual rights,
·
The duties of the Plan,
or
·
Other privacy practices
stated in this notice.
Disclosing Only
the Minimum Necessary Protected Health Information
When using or disclosing PHI or when
requesting PHI from another covered entity, the Plan will make
reasonable efforts not to use, disclose or request more than the
minimum amount of PHI necessary to accomplish the intended purpose
of the use, disclosure or request, taking into consideration
practical and technological limitations.
However, the minimum necessary
standard will not apply in the following situations:
·
Disclosures to or
requests by a health care provider for treatment,
·
Uses or disclosures made
to you,
·
Disclosures made to the
Secretary of the U.S. Department of Health and Human Services,
·
Uses or disclosures
required by law, and
·
Uses or disclosures
required for the Plan’s compliance with legal regulations.
This notice does not apply to
information that has been de-identified. De-identified information
is information that:
·
Does not identify you,
and
·
With respect to which
there is no reasonable basis to believe that the information can
be used to identify you.
In addition, the Plan may use or
disclose “summary health information” to the Plan Sponsor for
obtaining premium bids or modifying, amending or terminating the
group health Plan. Summary information summarizes the claims
history, claims expenses or type of claims experienced by
individuals for whom a Plan Sponsor has provided health benefits
under a group health fund. Identifying information will be deleted
from summary health information, in accordance with HIPAA.
Section 5: Your
Right to File a Complaint with the Plan or the HHS Secretary
If you believe that your privacy
rights have been violated, you may file a complaint with the Plan
in care of the following officer:
Administrative Manager
Fox Valley Laborers Health and Welfare
Fund
2400 Big Timber Road
Building B, Suite 206
Elgin, Illinois 60124-8810
You may also file a complaint with:
Secretary of the U.S. Department of
Health and Human Services
Hubert H. Humphrey Building
200 Independence Avenue S.W.
The Plan will not retaliate against
you for filing a complaint.
Section 6: If You
Need More Information
If you have any questions regarding
this notice or the subjects addressed in it, you may contact the
following officer at the Fund Office:
Administrative Manager
Fox Valley Laborers Health and Welfare
Fund
2400 Big Timber Road
Building B, Suite 206
Elgin, Illinois 60124-8810
Section 7: Conclusion
PHI use and disclosure by the Plan is
regulated by the federal Health Insurance Portability and
Accountability Act, known as HIPAA. You may find these rules at 45
Code of Federal Regulations Parts 160 and 164. This notice
attempts to summarize the regulations. The regulations will
supersede this notice if there is any discrepancy between the
information in this notice and the regulations.
