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HIPAA Statement

Click here for a HIPAA Authorization Form

 

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires the employer to maintain the confidentiality of health information that identifies the member. This extends to any other businesses that the employer must share information with.

 

The CSEA Employee Benefit Fund cannot disclose any personal health insurance information which includes dental, vision and Prescription Drug co-pay information about a member or their dependents to anyone other then the member. If you are calling on behalf of a member to assist them in claims inquiries, the Fund must have a signed HIPAA Authorization form on file before answers can be provided. This also applies if a spouse is calling about the other spouse or a child 18 years of age or older.

 

You may download a copy of this form or contact the EBF by calling (800) 323-2732. Forms on file are valid for two years from the date authorized.

 

CSEA Employee Benefit Fund Notice of Privacy Practices

As Required by the Privacy Regulations Promulgated Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Effective Date of this Notice: April 14, 2003

 

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO YOUR IDENTIFIABLE HEALTH INFORMATION.

PLEASE REVIEW THIS NOTICE CAREFULLY

 

1. OUR COMMITMENT TO YOUR PRIVACY:

Our organization is dedicated to maintaining the privacy of your identifiable health information. In conducting our business, we will create records regarding you and the services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and privacy practices concerning your identifiable health information. By law, we must follow the terms of the notice of privacy practices that we have in effect at the time.

 

To summarize, this notice provides you with the following important information:

 

The terms of this notice apply to all records containing your identifiable health information that are created or retained by our organization. We reserve the right to revise or amend our notice of privacy practices. Any revision or amendment to this notice will be effective for all of your records our organization has created or maintained in the past, and for any of your records we may create or maintain in the future. You may request a copy of our most current notice at any time.


2. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:

Lisa Brennan, Privacy Officer

CSEA Employee Benefit Fund, One Lear Jet Lane, Suite One, Latham, NY 12110-2395

(800) 323-2732 or (518) 782-1500.

 

3. WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION IN THE FOLLOWING WAYS:

The following categories describe the different ways in which we may use and disclose your identifiable health information.

  1. Treatment. Our organization may use identifiable health information in claims processing. For example, we may request x-rays and review them to determine the amount of benefits payable, taking into consideration the alternate treatment procedures that may accomplish a professionally acceptable result. Many of the people who work for our providers may use and disclose identifiable health information in order to assist in enrollees' benefits determination which may or may not affect treatment decisions made by the enrollee. Additionally, we may disclose identifiable health information to others, such as our dental consultants, to assist in the review of claims and benefit determination.
  2. Payment. Our organization may use and disclose your identifiable health information in order to pay for the services and items you may receive. For example, we may contact your health provider to certify that you received treatment, (and for what range of benefits), and we may request details regarding your treatment to determine if your benefits will cover, or pay for, your treatment. We also may use and disclose your identifiable health information to obtain payment from third parties that may be responsible for such costs.
  3. Health Care Operations. Our office may use and disclose your identifiable health information to operate our business. As examples of the ways in which we may use and disclose your information for our operations, our claims administrator may use your health information to evaluate the quality of care you received from your provider, or to conduct cost-management and business planning activities for our organization.
  4. Health-Related Benefits and Services. Our organization may use and disclose your identifiable health information to inform you of health-related benefits or services that may be of interest to you.
  5. Release of Information to Family Friends. Our organization may release your identifiable health information to a friend or family member that is helping you pay for your health care, or who assists in taking care of you, with written authorization.
  6. Disclosures Required By Law. Our organization will use and disclose your identifiable health information when we are required to do so by federal, state, or local law.


4. USE AND DISCLOSURE OF YOUR IDENTIFIABLE HEALTH INFORMATION IN CERTAIN SPECIAL CIRCUMSTANCES

The following categories describe unique scenarios in which we may use or disclose your identifiable health information:

1. Public Health Risks.

Our organization may disclose your identifiable health information to public health authorities that are authorized by law to collect information for the purpose of:


2. Health Oversight Activities.

Our organization may disclose your identifiable health information to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.


3. Lawsuits and Similar Proceedings.

Our organization may use and disclose your identifiable health information in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your identifiable health information in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.


4. Law Enforcement.

We may release identifiable health information if asked to do so by a law enforcement official:


5. Serious Threats to Health or Safety

Our organization may use and disclose your identifiable health information when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.


6. Military.

Our organization may disclose your identifiable health information if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate military command authorities.


7. National Security.

Our organization may disclose your identifiable health information to federal officials for intelligence and national security activities authorized by law. We also may disclose your identifiable health information to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.


8. Inmates.

Our organization may disclose your identifiable health information to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary; (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.


9. Workers Compensation.

Our organization may release your identifiable health information for worker's compensation and similar programs.


5. YOUR RIGHTS REGARDING YOUR IDENTIFIABLE HEALTH INFORMATION:

You have the following rights regarding the identifiable health information that we maintain about you:


1. Confidential Communications.

You have the right to request that our office communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home rather than work. In order to request a type of confidential communication, you must make a written request to, Lisa Brennan, Privacy Officer, CSEA Employee Benefit Fund, One Lear Jet Lane, Suite One, Latham, NY 12110-2395, specifying the requested method of contact, or the location where you wish to be contacted. Our organization will accommodate reasonable requests.


2. Requesting Restrictions.

You have the right to request a restriction in our use or disclosure of your identifiable health information for treatment, payment, or health care operations. Additionally, you have the right to request that we limit our disclosure of your identifiable health information to individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction in our use or disclosure of your identifiable health information, you must make your request in writing to, Lisa Brennan, Privacy Officer, CSEA Employee Benefit Fund, One Lear Jet Lane, Suite One, Latham, NY 12110-2395. Your request must describe in a clear and concise fashion: (a) the information you wish restricted; (b) whether you are requesting to limit our organization's use, disclosure or both; and (c) to whom you want the limits to apply.


3. Inspection and Copies.

You have the right to inspect and obtain a copy of the identifiable health information that may be used to make decisions about you, including medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to, Lisa Brennan, Privacy Officer, CSEA Employee Benefit Fund, One Lear Jet Lane, Suite One, Latham, NY, 12110-2395, in order to inspect and/or obtain a copy of your identifiable health information. Our organization may charge a fee for the costs of copying, mailing, labor and supplies associated with your request.


4. Amendment.

You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our organization. To request an amendment, your request must be made in writing and submitted to, Lisa Brennan, Privacy Officer, CSEA Employee Benefit Fund, One Lear Jet Lane, Suite One, Latham, NY, 12110-2395. You must provide us with a reason that supports your request for amendment. Our organization will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is: (a) accurate and complete; (b) not part of the identifiable health information kept by or for our organization; or (c) not created by our office, unless the individual or entity that created the information is not available to amend the information.


5. Accounting of Disclosures.

All of our enrollees have the right to request an 'accounting of disclosures'. An 'accounting of disclosures' is a list of certain disclosures our organization has made of your identifiable health information. In order to obtain an accounting of disclosures, you must submit your request in writing to, Lisa Brennan, Privacy Officer, CSEA Employee Benefit Fund, One Lear Jet Lane, Suite One, Latham, NY, 12110-2395. All requests for an 'accounting of disclosures' must state a time period which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12-month period is free of charge but our organization may charge you for additional lists within the same 12-month period. Our organization will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.


6. Right to File a Complaint.

If you believe your privacy rights have been violated, you may file a complaint with our organization or with the Secretary of Health and Human Services. To file a complaint with our organization, contact Lisa Brennan, Privacy Contact Person, CSEA Employee Benefit Fund, One Lear Jet Lane, Suite One, Latham, NY, 12110-2395. All complaints must be submitted in writing. You will not be penalized for filing a complaint.


7. Right to Provide an Authorization for Other Uses and Disclosures.

Our office will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your identifiable health information may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your identifiable health information for the reasons described in the authorization, except for the three situations noted below:


Please note, we are required to retain records of your care, as provided by law.


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