Notice of Privacy Practices
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.
Health Alliance Plan
Alliance Health and Life Insurance Company
HAP Midwest Health Plan, Inc.
Last Review: October 2015
Your Protected Health Information (PHI)
PHI stands for the words “Protected Health Information.” PHI is information about you, such as your name, demographic data and member ID number that can reasonably be used to identify you. This information relates to your past, present or future physical or mental health, the provision of health care to you or the payment for that care. Our policies cover protection of your PHI whether it’s oral, written or electronic.
Important Information About Privacy
Safeguarding the privacy of your PHI is important to HAP. We're required by law to protect the privacy of your PHI and to provide you with notice of our legal duties and privacy practices. That's what this notice is for. It explains how we use information about you and when we can share that information with others. It also tells you about your rights with respect to your PHI and how you can use your rights. We're required to comply with the terms set out in this notice.
When we use the term "HAP," "we" or "us" in this notice, we're referring to Health Alliance Plan and its subsidiaries, including Alliance Health and Life Insurance Company and HAP Midwest Health Plan, Inc.
How We Protect Your PHI
We protect your PHI, whether it's written, spoken or in electronic form, by requiring employees and others who handle your information to follow specific confidentiality and technology usage policies. When they begin working for HAP, all employees and contractors must acknowledge that they have reviewed HAP's policies and that they will protect your PHI even after they leave HAP. An employee or contractor's use of protected information is limited to the minimum amount of information necessary to perform a legitimate job function. Employees and contractors are also required to comply with this privacy notice and may not use or disclose your information except as described in this notice.
Using and Disclosing PHI
These next sections describe how HAP uses and shares your health information. Keep in mind that we share your information only with those who have a "need to know" in order to perform these tasks:
We may share your member information with your doctors, hospitals or other providers to help them provide medical care to you. If you are in the hospital for example, we may give them access to any medical records sent to us by your doctor.
We may use or share your PHI with others to help manage your health care. For example, we might talk to your doctor to suggest a disease management or wellness program that could help improve your health.
We may use or share your PHI to help us determine who is financially responsible for your medical bills. We may also use or share your PHI to conduct other payment activities, such as obtaining premium payments and determining eligibility for benefits and coordinating benefits with other insurance you may have.
We share your member information with affiliated companies as permitted by law, non-affiliated third parties with whom we contract to help us operate HAP and with others who are involved in providing or paying for health care services for you. We may share your information with others who help us conduct our business operations. If we do so, we will require these persons or entities to protect the privacy and security of your information and to return or destroy such information when it is no longer needed for our business operations.
Here are examples of business activities undertaken by HAP:
- 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, although we're prohibited from using or disclosing any genetic information for underwriting purposes
- 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
We may also disclose your PHI to other providers and health plans that have a relationship with you for certain health care operations. For example, we may disclose your PHI for their quality assessment and improvement activities or for health care fraud and abuse detection.
Other Uses and Disclosures that are Permitted or Required
HAP may also use or release your health information:
- For certain types of public health or disaster relief efforts
- To give you information about alternative medical treatments and programs or about health-related products and services that you may be interested in, such as information we might send you about smoking cessation or weight loss programs
- To give you reminders relating to your health, such as a reminder to refill a prescription, or to schedule recommended health screenings
- For research purposes; For example, a research organization that wishes to compare outcomes of all patients who receive a particular drug and must review a series of medical records. In all cases in which your specific authorization hasn't been obtained, your privacy will be protected by strict confidentiality requirements applied by an institutional review board or a privacy board, that oversees the research, or by representations of the researchers that limit their use and disclosure.
- To report information to state and federal agencies that regulate us, such as the U.S. Department of Health and Human Services, the Michigan Department of Financial and Insurance Services, the Michigan Department of Health and Human Services and the federal Centers for Medicaid and Medicare Services
- When needed by the employer or plan sponsor to administer your health benefit plan
- For certain FDA investigations, such as investigations of harmful events, product defects or for product recalls
- For public health activities if we believe there is a serious health or safety threat
- For health oversight activities authorized by law
- For court proceedings and law enforcement purposes
- To a government authority regarding abuse, neglect or domestic violence
- To a coroner or medical examiner to identify a deceased person, determine a cause of death or as authorized by law (We may also share member information with funeral directors to carry out their duties, as necessary.)
- To comply with workers' compensation laws
- For procurement, banking or transplantation of organs, eyes or tissue
- When permitted to be released to government agencies for protection of the president
We must obtain your written permission to use or disclose your PHI if one of these reasons doesn't apply. If you give us written permission, then change your mind, you may cancel your written permission at any time. Cancellation of your permission will not apply to any information we've already disclosed. We may ask you to complete a form when you make a request.
Other Uses of Health Information
- We may release your PHI to a friend, family member or other individual who is authorized by law to act on your behalf. For example, parents may obtain information about their children covered by HAP, even if the parent isn't covered by HAP.
- We may use or share your PHI with an employee benefit plan through which you receive health benefits. Except for enrollment information or summary health information and as otherwise required by law, we will not share your PHI with an employer or plan sponsor unless the employer or plan sponsor has provided us with written assurances that the information will be kept confidential and won't be used for an improper purpose. Generally, information will only be shared when it's needed by the employer or plan sponsor to administer your health benefit plan.
- We may give a limited amount of PHI to someone who helps pay for your care. For example, if your spouse contacts us about a claim, we may tell him or her whether or not the claim has been paid.
- We may use your PHI so that we can contact you, either by phone or by mail, in order to conduct surveys, such as the annual member satisfaction survey.
- In certain extraordinary circumstances, such as a medical emergency, we may release your PHI as necessary to a friend or family member who is involved in your care if we determine that the release of information is in your best interest. For example, if you have a medical emergency in a foreign country and are unable to contact us directly, we may speak with a friend or family member who is acting on your behalf.
Organized Health Care Arrangement
HAP and its affiliates covered by this Notice of Privacy Practices participate together with the Henry Ford Health System and its listed affiliates in an organized health care arrangement to improve the quality and efficient delivery of your health care and to participate in applicable quality measure programs, such as HEDIS.
The entities that comprise the HFHS OHCA are:
- Health Alliance Plan of Michigan
- Alliance Health and Life Insurance Company
- HAP Midwest Health Plan, Inc.
- HAP Preferred, Inc.
- The Henry Ford Health System
The HFHS Organized Health Care Arrangement permits these separate legal entities, including HAP and its affiliates, to share PHI with each other as necessary to carry out permissible treatment, payment or health care operations relating to the organized health care arrangement unless otherwise limited by law, rule or regulation. This list of entities may be updated to apply to new entities in the future. You can access the most current list at hap.org/privacy or call us at (800) 422-4641 to ask for a list. When required we'll provide you with appropriate notice of such purchase or affiliation in a revised Notice of Privacy Practices.
The following are your rights with respect to your member information. If you would like to exercise the following rights, please contact us as described below, under "Who to Contact."
- You have the right to ask us to restrict how we use or disclose your PHI for treatment, payment or health care operations. You also have the right to ask us to restrict PHI that we've been asked to give to family members or to others who are involved in your health care or in payment for your health care. We aren't required to agree to these additional restrictions, but if we do, we'll abide by them (except as needed for emergency treatment or as required by law) unless we notify you that we are terminating our agreement.
- You have the right to ask to receive confidential communications of PHI. For example, if you believe that you would be harmed if we send your PHI to your current mailing address (for example, in situations involving domestic disputes or violence); you can ask us to send the information by alternate means, by fax or to an alternate address. We will try to accommodate reasonable requests.
- You have the right to inspect and obtain a copy of PHI that we maintain about you. With certain exceptions, you have the right to look at or receive a copy of your PHI contained in the group of records used by or for us to make decisions about you, including our enrollment, payment, claims adjudication and case or medical management notes. If we deny your request for access, we'll tell you the basis for our decision and whether you have a right to further review. We may require you to complete a form to obtain this information and may charge you a fee for copies. We'll inform you in advance of any fee and provide you with an opportunity to withdraw or modify your request.
- You have the right to ask us to amend PHI we maintain about you. You have the right to request that we amend your PHI in the set of records you're granted access to upon your request. If we deny your request to amend them, we'll provide you with 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'll make reasonable efforts to inform others of the amendment, including individuals you name. We'll require that the information you provide be accurate. We are unable to delete any part of a legal record, such as a claim submitted by your doctor.
- You have the right to receive an accounting of certain disclosures of your PHI made by us during the six years prior to your request. HAP is not required to provide you with an accounting of all disclosures we make. For example, we aren't required to provide you with an accounting of PHI 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'll inform you in advance of the fee and provide you with an opportunity to withdraw or modify your request.
- You have the right to be informed of any data breaches that compromise your PHI. In the event of a breach of your unsecured PHI, we'll provide you with notification of such a breach as required by law or in cases in which we deem it appropriate.
- You have a right to receive a paper copy of this notice upon request at any time.
Your request to exercise any of these member rights must be in writing and it must 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 reserve the right to make periodic changes to the contents of this notice. If we do make changes, the new notice will be effective for all PHI maintained by us. Once we make our revisions, we'll 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, contact the HAP and HAP Midwest Health Plan Office of Compliance by mail at:
Health Alliance Plan
Attn: Office of Compliance
2850 West Grand Boulevard
Detroit, MI 48202
You may also call us at (800) 422-4641 (TTY: 711).
If you believe your privacy rights have been violated, you may file a complaint with us by contacting the Office of Compliance or by filing a grievance with our Customer Service 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 complaint.
Original effective date: April 13, 2003
Revisions: February 2005, November 2007, September 2013, September 2014, March 2015, October 2015
Reviewed: November 2008, November 2009, October 2011