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• You have the right to receive an accounting
of certain disclosures of your member information made by us during
the six years prior to your request. Please note that we are not required to provide you with an accounting of all
disclosures we make. For example, we are not required to provide you with an accounting of member information
collected prior to April 14, 2003; information disclosed or used for treatment, payment, and health care operations
purposes; or information disclosed to you or pursuant to your authorization.
Your first accounting in any 12-month period is free. However, if you request an additional accounting within 12
months of receiving your free accounting, we may charge you a fee. We will inform you in advance of the fee and
provide you with an opportunity to withdraw or modify your request.
• You have a right to receive a paper copy of this notice upon request at any time.
Your request to exercise any
of the above member rights must be in writing and be signed by you or your representative. We may ask you to
complete a form when making a request.
Changes to this Privacy Statement
We may from time-to-time change the contents of this notice and reserve the right to do so. If we do so the new notice
will be effective for all the member information maintained by us. Once revised, we will provide the new notice to you
by mail and post it on our website.
Who to Contact
If you have any questions about this notice or about how we use or share member information, you may contact the
HAP Privacy Officer by mail at:
Health Alliance Plan
Attn: Privacy Officer
2850 West Grand Blvd, Detroit, MI 48202.
You may also call us at (313) 872-8100 or 1-800-422-4641 or send us an e-mail by clicking “Contact HAP” at the top of
the page on HAP’s website (
If you believe your privacy rights have been violated, you may file a complaint with us by contacting the Privacy Officer
as noted above, or filing a grievance with the Client Services Department. You may also notify the Secretary of the
U.S. Department of Health and Human Services of your complaint. We will not take any action against you for filing a
Original Effective Date: 4/13/2003
Revisions: 2/05; 11/07; 9/13
Reviewed: 11/08; 11/09; 10/11
30M 212 9/13 0337