NOTICE OF PRIVACY PRACTICES
EASY CHOICE HEALTH PLAN OF NEW YORK
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
OUR COMMITMENT REGARDING YOUR PROTECTED HEALTH INFORMATION
This notice describes how we collect, share, and protect your nonpublic personal financial and health information (“Personal Information”) we receive about you and what we do to keep it confidential and secure, as required by the Gramm-Leach-Bliley Act (“GLBA”) and New York Regulation 169, 11 NYCRR 420; and how we use and disclose your protected health information (“PHI”), as required by the Health Information Portability and Accountability Act (“HIPAA”). We understand the importance of your Personal Information and PHI and follow strict polices (in accordance with state and federal privacy laws) to keep your Personal Information and PHI confidential and private. Our policies cover the protection of your Personal Information and PHI whether oral, written or electronic.
This notice informs you of the ways we may use and disclose your Personal Information and PHI. It also notifies you of your rights and our obligations in our use and disclosure of your Personal Information and PHI. We are required by federal and state laws to maintain the privacy of your health information, send you this notice, and abide by the terms of this notice. This notice explains how we use information about you and when we can share that information with others. It also informs you of your rights with respect to your health information and how you can exercise these rights. You have the right to request additional copies of this notice at any time by contacting the Privacy Officer identified below. For your convenience, you may also obtain an electronic (downloadable) copy of this notice online at www.easychoiceny.com
We must abide by the terms of this notice until we replace it. We reserve the right to change our privacy practices and the terms of this notice at any time, provided that applicable law permits such changes. We reserve the right to make the new changes apply to your Personal Information and PHI regardless of when it was created or received, before or after the effective date of the new notice. If we make a material change to our privacy practices, we will provide a revised notice to all persons to whom we are required to give the notice.
YOUR PERSONAL INFORMATION: WHAT WE COLLECT AND HOW IT IS USED
Easy Choice collects Personal Information you give us on applications, claim forms and other forms and Personal Information that you tell us (e.g. your name, date of birth, sex, address, Social Security number, and family member information). We also collect Personal Information about your dealings with us from the health care providers and other companies we work with. For example, we receive bills, physician reports, and other information about your medical care. We also collect information on your account balances and payment history. We may disclose your information as required or permitted by law. Our Health Plan needs to share members’ Personal Information to run its everyday business as a health plan: to provide health care coverage, arrange for treatment, pay for services, manage our business, maintain your account, respond to court orders and legal investigations, and comply with legal and regulatory requirements. We do not sell or otherwise make available any of your Personal Information to anyone and expressly not for marketing purposes. We may disclose your information for a legal or regulatory purpose. If your membership with the Health Plan ends, we may continue to share your information as described in this notice, and your Personal Information will remain protected in accordance with this notice.
HOW WE PROTECT YOUR PRIVACY
The Health Plan limits access to your Personal Information and PHI to employees who have been trained in our policies regarding privacy and affiliates and non-affiliated third-parties that have signed privacy and security agreements also called Business Associate Agreements, as needed, to conduct the Health Plan’s business or comply with legal and regulatory requirements.
Employees are subject to discipline and may be fired if they violate our privacy policies and procedures. Our third-party business associates are subject to corrective action and their contracts may be terminated if they violate the terms of their privacy and security agreements.
We also use administrative, physical and electronic safeguards to keep your Personal Information and PHI confidential and secure in accordance with state and federal regulations.
OUR USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
The following is a list of the ways in which we may use and disclose your health information. In some cases we provide examples of the types of uses or disclosures that fall within a particular category. These examples are intended to help you understand what these categories mean; they do not cover every type of use or disclosure within each category. When we make these disclosures, we must follow federal, state, and local laws that provide special protections for health information relating to HIV, mental health and alcohol and drug abuse treatment. We do not sell your PHI to anyone. We may use and disclose your PHI:
For Treatment: We may use and disclose your PHI to health care providers (doctors, dentists, pharmacies, hospitals and other caregivers) who request it in connection with providing health care to you. For example, we may disclose your PHI to health care providers to suggest disease and case management programs that could improve your health.
For Payment: We may use and disclose your PHI for our payment-related activities, including for example:
Obtaining premiums and determining eligibility for benefits
Paying claims for health care services that are covered by your health plan
Responding to inquiries, appeals and grievances
Coordinating benefits with other insurance you may have
For Health Care Operations: We may use and disclose your PHI for our health care operations, including for example:
Conducting quality assessment and improvement activities, including peer review, credentialing of providers and accreditation
Performing outcome assessments and health claims analyses
Preventing, detecting and investigating fraud and abuse
Underwriting, rating and reinsurance activities
Coordinating case and disease management activities
Communicating with you about treatment alternatives or other health-related benefits and services
Performing business management and other general administrative activities, including systems management and customer service
Coordinating health care operations with other providers and health plans that have a relationship with you, for example, to assist with their quality assessment improvement activities or health care fraud and abuse prevention or detection activities.
Sharing information with a sponsor, such as an employer group or association, of a benefit plan through which you receive health care coverage. We will not share detailed individually identifiable information with your plan sponsor unless they promise to keep it protected and use it only for purposes relating to the administration of your health benefits. We may, for example, share enrollment and disenrollment information.
Sharing information with Business Associates who help us conduct health plan operations, provided they agree to keep your information confidential
When Required by Law: We may use and disclose your PHI without your consent or authorization if we are required to do so by state and federal laws. For example, we may use and disclose your PHI in responding to court and administrative orders and subpoenas, to comply with workers’ compensation laws, to assist in government investigations, to assist public health agencies authorized by law to receive such information, to share or report information with state and federal agencies for health care oversight activities, special government functions or law enforcement purposes. We may disclose your PHI when required by the Secretary of Health and Human Services and state regulatory authorities. We may also use or disclose your PHI without your written permission for matters in the public interest, including for example:
Public health and safety activities, including disease and vital statistic reporting, child abuse reporting, and Food and Drug Administration oversight
Reporting adult abuse, neglect, or domestic violence
Reporting to organ procurement and tissue donation organizations
Other Permissible Uses and Disclosures: Uses and Disclosures for purposes, other than those listed above, will be made only with our written authorization. You may submit a request to revoke an authorization at any time. We require your revocation to be submitted in writing. To obtain the Authorization form, which describes the purpose for which the information will be disclosed, the time period during which the authorization will be in effect, and your right to revoke the authorization, please call the customer service number on the back of your membership card or visit our website at: www.easychoiceny.com.
YOUR HEALTH INFORMATION PRIVACY RIGHTS
Your Right to Access: With limited exceptions, you have the right to review or obtain copies of the PHI that we maintain about you and that we use in making decisions about your help. We may charge you a reasonable fee as allowed by law. To exercise your right, please call member services at the number on the back of your membership card to obtain an Authorization form or visit our website at: www.easychoiceny.com
Your Right to an Accounting of Disclosures: You have the right to request an "accounting of disclosures." This is a list of certain disclosures of your health information that we have made. To request this list of disclosures, you must submit a written request to the Privacy Officer. Please include the date of the request, your signature or the signature of your personal representative. Your request must state a time period for which the accounting is requested. The time period may not be longer than six years and may not include dates before your enrollment effective date with Easy Choice. You may receive one list per year without charge. We may charge you for the costs of providing additional lists within one year after your first request. We will notify you of the cost involved and you may choose to withdraw or modify your request if you do not wish to pay the cost.
Your Right to Request Restrictions: You have the right to request that we restrict the use or disclosure of your health information for treatment, payment, or healthcare operations. We are not required to agree to your request. To request restrictions or limitations, you must make a written request to the Privacy Officer. In your written request, you must tell us (1) what information you want to limit; (2) whether you want to limit use of the information and/or disclosure of the information; and (3) to whom the limitations or restrictions will apply. Please include the date of the request, your signature or the signature of your personal representative. The Privacy Officer will notify you in writing whether we have agreed to your request or not, with an explanation for the decision.
Your Right to Amendment: You have the right to request that we amend or correct the PHI that we maintain about you and that we use in making decisions about your help. If we deny your request, we will provide you a written explanation. If you disagree, you may have a statement of your disagreement placed in our records. If we accept your request to amend the information, we will make reasonable efforts to inform others, including individuals you name, of the amendment.
Your Right to Request Confidential Communications: You have the right to tell us how you would like us to communicate with you. For example, you may ask that we call you at a certain phone number, or you may tell us whether we may leave a message for you. To request confidential communications, you must make your request in writing to the Privacy Officer listed below. Your request must specify how or where you wish to be contacted. We will follow all reasonable requests for confidential communications.
Your Right to Request and Receive Privacy Notice: You have the right to request and receive a copy of this notice at any time. If you have agreed to receive the notice electronically, we will provide a paper copy of the notice upon request.
Complaints: If you believe your privacy rights have been violated, you may file a complaint with the Privacy Officer, call our Compliance Hotline at 1-877-296-0888 or the Member Services phone number on the back of your ID card. You may also file a complaint with the Office of Civil Rights of the United States Secretary of the Department of Health and Human Services. We encourage you feedback regarding our privacy policies, and we will not retaliate against you in anyway if you file a complaint. You may also download and complete our Suspected Compliance Violation Form from our website (www.easychoiceny.com
) and submit it to the contact information below.
For questions regarding this notice, to exercise any of your privacy rights, or to receive further information, please contact Easy Choice’s Privacy Officer at:
Easy Choice Health Plan of New York
45 Broadway, Suite 300
New York, NY 10006
Compliance Hotline: 1-877-296-0888