Notice of Privacy Practices

City of Wilson Notice of Privacy Practices
Employee Dental and Vision Plans
City Flexible Medical Spending Accounts
City of Wilson
P. O. Box 10
Wilson, NC   27894
 
 
 
 
 


Effective date of this notice:  04/14/04

 

 
 
 
 
 
If you have questions about this notice, please contact the person listed under “Whom to Contact” at the end of this notice.
 
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW THIS DOCUMENT CAREFULLY.
 
 
 

 

SUMMARY

 

 
In order to provide you with benefits, the City of Wilson Dental and Vision Plans, including the City’s Flexible Medical Spending Account (hereafter referred to as the “Plans”) will receive personal information about your health, from you, your physicians, dentists, or hospitals.  The Plans are required to keep this information confidential.  This notice of privacy practices is intended to inform you of the ways the Plans may use your information and the occasions on which the Plans may disclose this information to others.
 
 
The Plans use members’ health information to provide benefits.  The Plans disclose members’ information to health care providers to assist them in providing you with treatment or to help them receive payment.  The Plans may disclose information to other insurance companies as necessary to receive payment, the Plans may use the information within our organization to evaluate quality and improve health care operations, and the Plans may make other uses and disclosures of members’ information as required by law or as permitted by City of Wilson policies.
 
 
 

 

KINDS OF INFORMATION TO WHICH THIS NOTICE APPLIES

 

 
This notice applies to any information in the Plans’ possession that would allow someone to identify you and learn something about your health.  It does not apply to information that contains nothing that could reasonably be used to identify you.
 
 
 

 

WHO WILL ABIDE BY THIS NOTICE

 

 
  • City of Wilson Dental and Vision plans and the City’s Flexible Medical Spending Accounts
 
  • All employees, students and interns who work for the City of Wilson on behalf of the Plans and who have access to any protected health information about you and your covered dependents.
 
 
 
The people and organizations to which this notice applies (referred to as the “Plans,” “we,” “our,” and “us”) have agreed to abide by its terms.  The Plans may share your information with each other for purposes of treatment, and as necessary for payment and operations activities as described below.
 
 

 

OUR LEGAL DUTIES

 

 
  • The Plans are required by law to maintain the privacy of your health information.
 
  • The Plans are required to provide this notice of our privacy practices and legal duties regarding health information to anyone who asks for it.
 
  • The Plans are required to abide by the terms of this notice until the Plans officially adopt a new notice.

 

 

 

HOW THE PLANS MAY USE OR DISCLOSE YOUR INFORMATION

 

 
 
The Plans may use your health information, or disclose it to others, for a number of different reasons.   For each reason, the Plans have written a brief explanation.  The Plans also provide some examples.  These examples do not include all of the specific ways the Plans may use or disclose your information.  But any time the Plans use your information or disclose it to someone else, it will fit one of the reasons listed here.
 
 
 
1.  Treatment:  The Plans may use your health information to assist you in obtaining medical care and services.  For example, if you are unable to provide information as the result of an accident, the Plan may advise an emergency room physician the name of your dentist.
 
 
2.  Payment:  We may use or disclose your health information to obtain payment for services    we provide to you.  For example, the Plan may receive and maintain information about a dental procedure you received to enable the Plan to process a dental claim.
 
 
3.  Health Care Operations:  The Plans may use and disclose your health information for activities that are necessary to operate it, or operate it more efficiently, and to make certain all of the Plans’ participants receive their health benefits.  For example, the Plans may disclose your health information, and the information of other members, as necessary to others with whom the Plans contract to provide administrative services, to perform population-based studies designed to reduce health care costs, or to plan what services the Plans need to provide, expand, or reduce.  In addition, the Plans may use or disclose your PHI to our lawyers, auditors, and consultants to conduct compliance reviews, audits, actuarial studies, and/or for fraud and abuse detection.  The Plans may also combine health information about many Plan participants and disclose it to the City of Wilson in summary fashion so it can decide what coverage the Plan should provide.  The Plans may remove information that identifies you from health information disclosed to the City of Wilson so it may be used without learning who the specific participants are.
 
 
4.  Legal Requirement to Disclose Information: We may use or disclose your health information when we are required to do so by law.  For example, the Plans may be required to disclose your health information, and the information of others, if the Plans are audited by  government agencies charged with monitoring health care systems and enforcing State or Federal regulations with which the Plans must comply.  The Plans will also disclose your health information when the Plans are required to do so by a court order or other judicial or administrative process.
 
 
5.  Public Health Activities:  The Plans will disclose your health information when required to do so for public health purposes.  These activities include preventing or controlling disease, injury or disability or reporting reactions to medication or problems with medical products or to notify people of recalls of products they have been using.
 
 
6.  To Report Abuse:  The Plans may disclose your health information when the information relates to a victim of abuse, neglect or domestic violence.  The Plans will make this report only in accordance with laws that require or allow such reporting, or with your permission.
 
 
7.  Law Enforcement:  The Plans, to the degree allowed by law, may disclose your health information for law enforcement purposes.  This includes providing information to help locate a suspect, fugitive, material witness or missing person, or in connection with suspected criminal activity.  The Plans must also disclose your health information to a federal agency investigating our compliance with privacy regulations. 
 
 
8.  Specialized Purposes:  The Plans may disclose your health information for specialized purposes. The Plans will only disclose as much information as is necessary for the particular purpose.  For example, the Plans may disclose your health information to the City of Wilson as your employer for purposes of Workers’ Compensation and worksite safety laws (OSHA, for instance).
 
 
9.  To Avert A Serious Threat:  The Plans may disclose your health information if the Plans decide that the disclosure is necessary to prevent serious harm to the Public or to an individual.  The disclosure will only be made to someone who is able to prevent or reduce the threat.
 
10.  Family and Friends:  The Plans may disclose your health information to a member of your family or to someone else who is involved in your medical care or payment for care.  This may include investigating and reporting claims status and benefit entitlements with a family member.  In the event of a disaster, the Plans may provide information about you to a disaster relief organization so they can notify your family of your condition and location.  The Plans will not disclose your information to family or friends if you object.
 
 
11.  Health Benefits Information:  Your health information may be disclosed to the City of Wilson by the health plan as necessary for the administration of your employer’s health benefit program for employees.  The City of Wilson may receive this information only for purposes of administering their employee group health plans, and has special rules to prevent the misuse of your information for other purposes.
 
 

 

YOUR RIGHTS

 

 
 
1.  Authorization:  The Plans may use or disclose your health information for any purpose that is listed in this notice without your written authorization.  The Plans will not use or disclose your health information for any other reason without your authorization.  If you authorize the Plans to use or disclose your health information, you have the right to revoke the authorization at any time.  For information about how to authorize us to use or disclose your health information, or about how to revoke an authorization, contact the person listed under “Whom to Contact” at the end of this notice.  You may not revoke an authorization for the Plans to use and disclose your information to the extent that the Plans have taken action in reliance on the authorization.  If the authorization is to permit disclosure of your information to an insurance company, as a condition of obtaining coverage, other law may allow the insurer to continue to use your information to contest claims or your coverage, even after you have revoked the authorization.
 
 
2.  Request Restrictions:  You have the right to ask us to restrict how the Plans use or disclose your health information.  The Plans will consider your request.  But the Plans are not required to agree.  If the Plans do agree, the Plans will comply with the request unless the information is needed to provide you with emergency treatment.  The Plans cannot agree to restrict disclosures that are required by law.
 
 
3. Confidential Communication:  If you believe that the disclosure of certain information could endanger you, you have the right to ask us to communicate with you at a special address or by special means.  For example, you may ask us to speak to you personally on the telephone rather than discuss your health information with your spouse.  The Plans will agree to any reasonable request.
 
 
4.  Inspect And Receive a Copy of Health Information:  You have a right to inspect the health information about you that the Plans have in our records, and to receive a copy of it.  This right is limited to information about you that is kept in records that are used to make decisions about you.  For instance, this includes dental and vision claims and enrollment records.  If you have to review or receive a copy of these records, you must make the request in writing.  The Plans may charge a fee for the cost of copying and mailing the records.  To ask to inspect your records, or to receive a copy, contact the person listed under “Whom to Contact” at the end of this notice.  The Plans will respond to your request within 30 days. The Plans may deny you access to certain information.  If the Plans do, the Plans will give you the reason, in writing.  The Plans will also explain how you may appeal the decision.
 
 
5.  Amend Health Information:  You have the right to ask the Plans to amend health information about you that you believe is not correct, or not complete.  You must make this request in writing, and give us the reason you believe the information is not correct or complete.  The Plans will respond to your request in writing within 30 days.  The Plans may deny your request if the Plans did not create the information, if it is not part of the records the Plans use to make decisions about you, if the information is something you would not be permitted to inspect or copy, or if the information is complete and accurate.
 
 
6. Accounting Disclosures:  You have a right to receive an accounting of certain disclosures of your information to others.  This accounting will list the times The Plans have given your health information to others.  The list will include dates of the disclosures, the names of the people or organization to whom the information was disclosed, a description of the information, and the reason.  The Plans will provide the first list of disclosures you request at no charge.  The Plans may charge you for any additional lists you request during the following 12 months.  You must tell us the time period you want the list to cover.  You may not request a time period longer than six years.  The Plans cannot include disclosures made before April 14, 2004.  Disclosures for the following reasons will not be included on the list:  disclosures for treatment, payment, or health care operations; disclosures for national security purposes; disclosures to correctional or law enforcement personnel; disclosures that you have authorized; and disclosures made directly to you.
 
 
7.  Complaints:  You have a right to complain about the Plans privacy practices, if you think your privacy has been violated.  You may file your complaint with the person listed under “Whom to Contact” at the end of this notice.  You may also file a complaint directly with the Secretary of the U.S. Department of Health and Human Services, at the Office of Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F HHH Bldg., Washington, D.C. 20201.  All complaints must be in writing.  The Plans will not take any retaliation against you if you file a complaint.
 
 

 

OUR RIGHT TO CHANGE THIS NOTICE

 

 
 
The Plans reserve the right to change our privacy practices, as described in this notice, at any time.  The Plans reserve the right to apply these changes to any health information that the Plans already have, as well as to health information the Plans receive in the future.  Before the Plans make any change in the privacy practices described in this notice, the Plans will write a new notice that includes the change.  The new notice will include an effective date.  We will mail the new notice to all employees within 60 days of the effective date.
 
 

 

WHOM TO CONTACT:

 

 
 
Contact the person listed below:
  • For more information about this notice, or
  • For more information about our privacy policies, or
  • If you want to exercise any of your rights, as listed on this notice, or
  • If you want to request a copy of our current notice of privacy practices.
 
 
Suzanne B. Allen, Human Resources and Risk Services Director
City of Wilson
PO Box 10
Wilson, NC  27894-0010
(252) 399-2246