YOUR RIGHTS UNDER CAREMORE HEALTH PLAN
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY. This notice is effective as of September 23, 2016.
Dear CareMore Member/Patient,
CareMore is an innovative health plan and care delivery system providing services to members and patients in eight states. As a member and/or patient of CareMore you may receive services from a CareMore Health Care Provider.
This notice explains the privacy of your health information. CareMore already follows current state confidentiality laws, but the federal government now requires that this notice be given to help educate members and patients about their rights.
Please let us help if you have any questions or concerns about this notice or your privacy rights.
CareMore is required by law to maintain the privacy of Protected Health Information (“PHI”) and to provide you with notice of our legal duties and privacy practices with respect to PHI and to notify affected individuals following a breach of unsecured PHI. PHI is information that may identify you and that relates to your past, present, and future physical or mental health or condition and related health care services.
This Notice of Privacy Practices (“Notice”) describes how we may use and disclose PHI to carry out treatment, payment or health care operations and for other specified purposes that are permitted or required by law. The Notice also describes your rights with respect to your PHI. We are required to provide this notice to you by the Health Insurance Portability and Accountability Act (“HIPAA”)§ 164.520.
CareMore is required to follow the terms of this Notice. We will not use or disclose your PHI without your written authorization, except as described or otherwise permitted by this Notice. We reserve the right to change our practice and this Notice and to make the Notice effective for all PHI we maintain upon request, or with any material change we will provide any revised Notice to you.
We may collect, use and share your nonpublic personal information (PI) as described in this notice. PI identifies a person and is often gathered in an insurance matter.
We may collect PI about you from other persons or entities, such as doctors, hospitals or other carriers. We may share PI with persons or entities outside of our company — without your OK in some cases. If we take part in an activity that would require us to give you a chance to opt out, we will contact you. We will tell you how you can let us know that you do not want us to use or share your PI for a given activity. You have the right to access and correct your PI. Because PI is defined as any information that can be used to make judgments about your health, finances, character, habits, hobbies, reputation, career and credit, we take reasonable safety measures to protect the PI we have about you. A more detailed state notice is available upon request. Please call the phone number printed on your ID card.
Examples of How We Use and Disclose Protected Health Information About You:
The following categories describe different ways that we use and disclose your protected health information. We have provided you with examples in certain categories; however, not every use or disclosure in a category will be listed.
Treatment. We may use your health information to provide and coordinate the treatment, medications, and services you receive. For example, we may order diagnostic tests, prescribe medications or provide wound care. We will need to talk with your treating physician so that we can coordinate services and develop a plan of care. We also may need to refer you to another healthcare provider to receive certain services. We will share information with that healthcare provider in order to coordinate your care and services.
Payment. We may use your health information for various payment-related functions. For example, we may need to give health information to your health plan when a cost share amount applies to a service we provide to you. We may also communicate updates for the Program to the Health Plan Care Management Staff.
Health Care Operations. We may use your health information for certain operational, administrative, and quality assurance activities. For example, we may use information in your health record to monitor the performance of the staff providing treatment to you. This information will be used in an effort to continually improve the quality and effectiveness of the health care and service we provide. We may disclose health information to business associates if they need to receive this information to provide a service to us and will
agree to abide by specific HIPAA rules relating to the PHI.
We may also use your health information to provide you with information about benefits available to you, and, in limited situations, about health related products or services that may be of interest to you.
We are permitted to use or disclose your PHI for the following purposes. However, CareMore may never have reason to make some of these disclosures.
To Communicate with Individuals Involved in Your Care or Payment for Your Care. We may disclose to a family member, other relative, close personal friend, personal representative or any other person you identify, PHI directly relevant to that person’s involvement in your care or payment related to your care. If you are not present, if it is an emergency, or you are not able to tell us it is OK, we may give your PHI to a family member, friend or other person if sharing your PHI is in your best interest.
Food and Drug Administration (FDA). We may disclose to the FDA, or persons under the jurisdiction of the FDA, PHI relative to adverse events with respect to drugs, foods, supplements, products, and products defects, or post-marketing surveillance information to enable product recalls, repairs, or replacements.
Worker’s Compensation. We may disclose your PHI to the extent authorized and to the extent necessary to comply with laws relating to workers’ compensation or other similar programs established by law.
Public Health. As required by law, we may disclose your PHI to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
Law Enforcement. We may disclose your PHI or law enforcement purposes as required by law or in response to a subpoena or court order.
As Required by Law. We will disclose your PHI when required to do so by federal, state, or local law.
Health Oversight Activities. We may disclose your PHI to an oversight agency for activities authorized by law. These oversight activities include audits, investigations, inspections, and credentialing, as necessary for licensure and for the government to monitor the health care system, government programs, and compliance with civil right laws.
Judicial and Administrative Proceedings. If you are involved in a lawsuit or dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process instituted by someone else involved in the dispute, but only if efforts have been made, either by the requesting party or us, to tell you about the request or to obtain an order protecting the information requested.
Research. We may disclose your PHI to researchers when their research has been approved by an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your information.
Coroners, Medical Examiners, and Funeral Directors. We may release your PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also disclose PHI to funeral directors consistent with applicable law to enable them to carry out their duties.
Organ or Tissue Procurement Organizations. Consistent with applicable law, we may disclose your PHI to organ procurement organizations or other entities engaged in the procurement banking, or transplantation of organs for the purpose of tissue donation and transplant.
Notification. We may use or disclose your PHI to notify or assist in notifying a family member, personal representative, or another person responsible for your care, regarding your location and general condition.
Correctional Institution. If you are or become an inmate of a correctional institution, we may disclose to the institution or its agents, PHI necessary for your health and the health and safety of other individuals.
To Avert a Serious Threat to Health or Safety. We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
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.
National Security, Intelligence Activities, and Protective Services for the President and Others. We may release PHI about you to federal officials for intelligence, counter intelligence, protection of the president, and other national security activities authorized by law.
Victims of Abuse or Neglect. We may disclose PHI about you to a government authority if we reasonably believe you are a victim of abuse or neglect. We will only disclose this type of information to the extent required by law, if you agree to the disclosure, or if the disclosure is allowed by law and we believe it is necessary to prevent serious harm to you or someone else.
Other Uses and Disclosure of PHI. We will obtain your written authorization before using or disclosing your PHI for purposes other than those provided for above (or as otherwise permitted or required by law). You may revoke an authorization in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing your PHI, except to the extent that we have already taken action in reliance on the authorization.
We will also obtain your authorization for the use and disclosure of psychotherapy notes (if maintained by CareMore), marketing, (where an authorization is required) and the sale of PHI.
Genetic information. We cannot use or disclose PHI that is an individual’s genetic information for underwriting.
Race, Ethnicity, and Language. We may receive race, ethnicity, and language information about you and protect this information as described in this Notice. We may use this information for various health care operations which include identifying health care disparities, developing care management programs and educational materials, and providing interpretation services. We do not use race, ethnicity, and language information to perform underwriting, rate setting or benefit determinations, and we do not disclose this information to unauthorized persons.
Your Health Information Rights:
Obtain a paper copy of the Notice upon request. You may request a copy of our current Notice at any time. Even if you have agreed to receive the Notice electronically, you are still entitled to a paper copy. You may obtain a paper copy from any CareMore location or our Privacy Office.
Request a restriction on certain uses and disclosures of PHI. You have the right to request additional restrictions on our use or disclosure of your PHI that include a health care item or service that you have paid for in full and is not otherwise required to be disclosed by law, by sending a written request to the Privacy Office. We are not required to agree to those restrictions. We cannot agree to restrictions on uses or disclosures that are legally required, or which are necessary to administer our business.
Inspect and obtain a copy of PHI. In most cases, you have the right to access and copy the PHI that we maintain about you. To inspect or copy your PHI, you must send a written request to the Privacy Office. We may charge you a fee for the costs of copying, mailing, and supplies that are necessary to fulfill your request. We may deny your request to inspect and copy in certain limited circumstances.
Request an amendment of PHI. If you feel the PHI we maintain about is incomplete or incorrect, you may request that we amend it. To request an amendment, you must send a written request to the Privacy Office. You must include a reason that supports your request. In certain cases, we may deny your request for amendment.
Receive an accounting of disclosures of PHI. You have the right to receive an accounting of the disclosures we have made of your PHI after April 14, 2003, for most purposes other than treatment, payment, or health care operations. The right to receive an accounting is subject to certain exceptions, restrictions, and limitations. To request an accounting, you must submit a request in
writing to the Privacy Office. Your request must specify the time period. The time period may not be longer than six years and may not include dates before April 14, 2003.
Request communication of PHI by alternative means or at alternative locations. For instance, you may request that we contact you at a different residence or post office box. To request confidential communication of your PHI, you must submit a request in writing to the Privacy Office. Your request must tell us how or where you would like to be contacted. We will try to accommodate all reasonable requests.
Where to obtain forms for submitting written requests. You may obtain forms for submitting written requests from our Privacy Office at:
Attention: Privacy Office
12900 Park Plaza Dr., Suite 150
Cerritos, CA 90703
Or by telephone at: (562) 677-2402
Incidental Disclosures. CareMore will make reasonable efforts to avoid incidental disclosures of protected health information.
Minors. If you are a minor who has lawfully provided consent for treatment and you wish for CareMore to treat you as an adult for purposes of access to and disclosure of records related to such treatment, please notify the Privacy Office.
If you believe your privacy rights have been violated, you can file a complaint with the Privacy Officer or with the Secretary of Health and Human Services. There will be no retaliation for filling a complaint.
The most recent revision date of this notice is September 23, 2016.
Breast reconstruction surgery benefits.
If you ever need a benefit-covered mastectomy, we hope it will give you some peace of mind to know that your CareMore benefits comply with the Women’s Health and Cancer Rights Act of 1998, which provides for:
- Reconstruction of the breast(s) that underwent a covered mastectomy.
- Surgery and reconstruction of the other breast to restore a symmetrical appearance.
- Prostheses and coverage for physical complications related to all stages of a covered mastectomy, including lymphedema.
All applicable benefit provisions will apply, including existing deductibles, copayments and/or co-insurance. Contact your Plan administrator for more information.
For more information about the Women's Health and Cancer Rights Act, you can go to the federal Department of Labor website at: dol.gov/ebsa/publications/whcra.html.
For more information, or to report a problem.
If you have questions or would like additional information about CareMore’s privacy practices, you may call or write our Privacy Officer at:
Attention: Privacy Office
12900 Park Plaza Dr., Suite 150
Mail Stop MSCA4600-6170
Cerritos, CA 90703
It’s important we treat you fairly
That’s why we follow federal civil rights laws in our health programs and activities. We don’t discriminate, exclude people, or treat them differently on the basis of race, color, national origin, sex, age or disability. For people with disabilities, we offer free aids and services. For people whose primary language isn’t English, we offer free language assistance services through interpreters and other written languages.
Interested in these services?
Call the Member Services number on your ID card for help (TTY/TDD: 711). If you think we failed to offer these services or discriminated based on race, color, national origin, age, disability, or sex, you can file a complaint, also known as a grievance. You can file a complaint with our Compliance Coordinator in writing to Compliance Coordinator, P.O. Box 27401, Mail Drop VA2002-N160, Richmond, VA 23279. Or you can file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights at 200 Independence Avenue, SW; Room 509F, HHH Building; Washington, D.C. 20201 or by calling 1-800-368-1019 (TDD: 1- 800-537-7697) or online at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html
This notice is effective as of September 23, 2016.
Printable Version of Notice of Privacy Practices (English)
Printable Version of Notice of Privacy Practices (Spanish)