NOTICE OF NEW ENGLAND HEALTH CARE EMPLOYEES
WELFARE FUND PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW THE FUND’S MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
USE AND DISCLOSURE OF HEALTH INFORMATION
The Welfare Fund may use your health information, that is, information that constitutes protected health information as defined in the Privacy Rule of the Administrative Simplification provision of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), for purposes of making or obtaining payment for your care and conducting its health care operations. The Welfare Fund has established a policy to guard against unnecessary or inappropriate disclosure of your health information.
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH, YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED:
To Make or Obtain Payment. The Welfare Fund may use or disclose your health information to make payment to or collect payment from third parties, such as other health plans or providers, for the care you receive. For example, the Welfare Fund may provide information regarding your coverage or health care treatment to other health plans to coordinate payment of benefits.
To Conduct Health Care Operations. The Welfare Fund may use or disclose health information for its own operations and administration and as necessary to provide coverage and services to all of the Welfare Fund’s participants. Health care operations includes such activities as:
- Quality assessment and improvement activities.
- Activities designed to improve health or reduce health care costs.
- Clinical guideline and protocol development, case management and care coordination.
- Contacting health care providers and participants with information about treatment alternatives and other related functions.
- Health care professional competence or qualifications review and performance evaluation.
- Accreditation, certification, licensing or credentialing activities.
- Functions to create, renew or replace health insurance or health benefits.
- Review and auditing, including compliance reviews, medical reviews, legal services and compliance programs.
- Business planning and development including cost management and planning related analyses and formulary development.
- Business management and general administrative activities of the Welfare Fund, including participant service and resolution of internal grievances.
- To make eligibility determinations, conduct case management, quality improvement and utilization review, and provider credentialing activities or to engage in customer service and grievance resolution activities.
Disclosure to the New England Health Care Employees Pension Fund. The Welfare Fund may disclose your health information to the New England Health Care Employees Pension Fund to enable the Pension Fund to make eligibility determinations if you apply for a Pension Fund benefit.
For Treatment Alternatives. The Welfare Fund may use and disclose your health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
For Distribution of Health-Related Benefits and Services. The Welfare Fund may use or disclose your health information to provide to you information on health-related benefits and services that may be of interest to you.
For Disclosure to the Plan Sponsor. The Welfare Fund may disclose your health information for plan administration functions. The Welfare Fund also may provide summary health information to solicit premium bids from other health plans or modify, amend or terminate the plan.
For Resolving Liens, Subrogation Claims. The Welfare Fund may use or disclose your health information to your legal representative in order to resolve Fund liens in third party liability cases.
When Legally Required. The Welfare Fund will disclose your health information when it is required to do so by any federal, state or local law.
To Conduct Health Oversight Activities. The Welfare Fund may disclose your health information to a health oversight agency for authorized activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. The Welfare Fund, however, may not disclose your health information if you are the subject of an investigation and the investigation does not arise out of or is not directly related to your receipt of health care or public benefits.
In Connection With Judicial and Administrative Proceedings. As permitted or required by state law, the Welfare Fund may disclose your health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a subpoena, discovery request or other lawful process, but only after the Welfare Fund makes reasonable efforts to notify you about the request.
For Law Enforcement Purposes. As permitted or required by state law, the Welfare Fund may disclose your health information to a law enforcement official for certain law enforcement purposes.
In the Event of a Serious Threat to Health or Safety. The Welfare Fund may, consistent with applicable law and ethical standards of conduct, disclose your health information if the Fund, in good faith, believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.
For Specified Government Functions. In certain circumstances, federal regulations require the Welfare Fund to use or disclose your health information to facilitate specified government functions related to the military and veterans, national security and intelligence activities and protective services for the president and others.
For Worker’s Compensation. The Welfare Fund may release your health information to the extent necessary to comply with laws related to Worker’s Compensation or similar programs.
AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION
Other than as stated above, the Welfare Fund will not disclose your health information other than with your written authorization. If you authorize the Welfare Fund to use or disclose your health information, you may revoke that authorization in writing at any time.
YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
You have the following rights regarding your health information that the Welfare Fund maintains:
Right to Request Restrictions. You may request restrictions on certain uses and disclosures of your health information. You have the right to request a limit on the Welfare Fund disclosure of your health information to someone involved in the payment of your care. However, the Welfare Fund is not required to agree to your request. If you wish to make a request for restrictions, please contact the Welfare Fund Privacy Officer at 1-800-227-4744 and ask to have the Request For Restrictions on Use and/or Disclosure of PHI Form sent to you. Fill out the form and send the form to the Welfare Fund Privacy Officer, 77 Huyshope Avenue 2nd Floor, Hartford, CT 06106-7001 (fax number is 860-947-8080). The Welfare Fund will attempt to honor your reasonable requests for restrictions on disclosures of your health information.
Right to Receive Confidential Communications. You have the right to request that the Welfare Fund communicate with you in a specified manner if you feel the disclosure of your health information could endanger you. For example, you may ask that the Welfare Fund only communicate with you at a certain address, telephone number or by email. If you wish to receive confidential communications, please call the Welfare Fund and ask to have the Participant Request For Confidential Communication Form sent to you. Fill out the form and send the form to the Welfare Fund Privacy Officer, 77 Huyshope Avenue 2nd Floor, Hartford, CT 06106-7001 (fax number is 860-947-8080). The Welfare Fund will attempt to honor your reasonable requests for confidential communications.
Right to Inspect and Copy Your Health Information. You have the right to inspect and copy your health information. If you wish to request access to your protected health information, please call the Welfare Fund and ask to have the Request For Access to Protected Information Form sent to you. Fill out the form and send the form back to the Welfare Fund Privacy Officer, 77 Huyshope Avenue 2nd Floor, Hartford, CT 06106-7001 (fax number is 860-947-8080). If you request a copy of your health information, the Welfare Fund may charge a reasonable fee for copying, assembling costs and postage, if applicable, associated with your request.
Right to Amend Your Health Information. If you believe that your health information records are inaccurate or incomplete, you may request that the Welfare Fund amend or supplement the records. Your request may be made as long as the information is maintained by the Welfare Fund. If you wish to amend or correct your protected health information, please call the Welfare Fund and ask to have the Request For Amendment/Correction of Protected Information Form sent to you. Fill out the form and send the form back to the Welfare Fund Privacy Officer, 77 Huyshope Avenue 2nd Floor, Hartford, CT 06106-7001( fax number is 860-947-8080). The Welfare Fund may deny the request if it does not include a reason to support your proposed correction or amendment. The request also may be denied if your health information records were not created by the Welfare Fund, if the health information you are requesting to amend is not part of the Welfare Fund records, if the health information you wish to amend falls within an exception to the health information you are permitted to inspect and copy, or if the Welfare Fund determines that the records containing your health information are accurate and complete.
Right to an Accounting. You have the right to request a list of disclosures of your health information made by the Welfare Fund for any reason other than for treatment, payment or health operations. If you wish to request disclosures of your protected health information, please call the Welfare Fund and ask to have the Request For An Accounting of Disclosures Form sent to you. Fill out the form and send the form back to the Welfare Fund Privacy Officer, 77 Huyshope Avenue 2nd Floor, Hartford, CT 06106-7001 (fax number is 860-947-8080). The request should specify the time period for which you are requesting the information, but in no event earlier than April 14, 2006. Accounting requests may not be made for periods of time going back more than six (6) years, but in no event earlier than April 14, 2006. The Welfare Fund will provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee. The Welfare Fund will inform you in advance of the fee, if applicable.
Right to a Paper Copy of this Notice. You have a right to request and receive a paper copy of this Notice at any time, even if you have received this Notice previously or agreed to receive the Notice electronically. To obtain a paper copy, please contact Welfare Fund Privacy Officer, 77 Huyshope Avenue 2nd Floor, Hartford, CT 06106-7001 (fax number is 860-947-8080).
DUTIES OF THE WELFARE FUND
The Welfare Fund is required by law to maintain the privacy of your health information as set forth in this Notice and to provide you this Notice of its privacy practices and policies. The Welfare Fund is required to abide by the terms of this Notice, which may be amended from time to time.
The Welfare Fund reserves the right to change the terms of this Notice and to make the new Notice provisions effective for all health information that it maintains. If the Welfare Fund changes its policies and procedures, the Fund will revise the Notice and will provide a copy of the revised Notice to you within 60 days of the change.
You have the right to file complaints with the Welfare Fund and with the Secretary of the Department of Health and Human Services if you believe that your privacy rights have been violated. Any complaints to the Welfare Fund should be made in writing to the Welfare Fund Privacy Officer, 77 Huyshope Avenue 2nd Floor, Hartford, CT 06106-7001 (fax number is 860-947-8080). The Welfare Fund encourages you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.
Complaints filed directly with the Secretary must be made in writing to the Secretary of the Department of Health and Human Services, 200 Independence Avenue, S.W.; Washington, DC 20201. The letter must name the entity against whom the complaint is lodged, must describe the acts or omissions complained of and must be filed within 180 days of the time you became aware of the violation.
CONTACT PERSON
The Welfare Fund has designated the Welfare Fund Privacy Officer as its contact person for all issues regarding participant privacy and your privacy rights. You may contact this person at 77 Huyshope Avenue 2nd Floor, Hartford, CT 06106-7001. The telephone number is
1-800-227-4744.
EFFECTIVE DATE
This Notice is effective December 1, 2017.
If you have any questions regarding this notice, contact the Welfare Fund Privacy Officer, 77 Huyshope Avenue 2nd Floor, Hartford, CT 06106-7001. The telephone number is 860-227-4744.
