Notice of Privacy Practices
What is Protected Health Information (PHI)?
How we may use and disclose your PHI
Uses and disclosures that require your prior written authorization
Your rights regarding your PHI
Right to receive KS Plan Administrator LLC's Notice of Privacy Practices
How to obtain information about this notice or complain about our privacy practices
Changes to this notice
Effective date of this notice
KelseyCare Advantage’s Notice of Privacy Practices
KS Plan Administrators LLC is committed to ensuring the privacy and confidentiality of our members’ Protected Health Information (PHI) and fully supports the provisions of the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
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.
KS Plan Administrators LLC is committed to safeguarding the confidentiality of your personal health information. In order to effectively provide and administer services and benefits to you, KS Plan Administrators LLC must collect and disclose certain protected health information. This is only done, however, in accordance with KS Plan Administrators LLC’s privacy policies. In addition, Federal and state law require that we guard the privacy of your protected health information. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
This Notice of Privacy Practices describes how KS Plan Administrators LLC may collect, use and disclose your protected health information, and your rights concerning your protected health information. Protected health information is information about you or your dependents, including demographic information, that can reasonably be used to identify you and that relates to your past, present, or future physical or mental health or condition, the provision of health care service to you or our payment for that care. We are required to safeguard your protected health information and to provide you with this notice about our legal duties and privacy practices. We must follow the privacy practices described in this notice while it is in effect.
This notice takes effect April 1, 2007 and will remain in effect until we replace or modify it.
What is Protected Health Information (PHI)?
Whether based on our confidentiality policy or pertinent law, KS Plan Administrators LLC safeguards the privacy of your protected health information (“PHI”). PHI is information that alone, or in conjunction with other data that we collect from or about you, would allow you to be identified. For example, medical information used to help members get needed care, or information about payments for services you have received, as well as descriptive information about those services, is PHI.
How we may use and disclose your PHI
In order to provide coverage for treatment and pay for those services, we need to use and disclose your PHI in a number of different ways. KS Plan Administrators LLC staff is trained in the appropriate handling of your PHI and execute their specific responsibilities using only that information required for their role. KS Plan Administrators LLC maintains and enforces policies governing the use of PHI by workforce members to ensure their proper handling. Procedures to afford these internal protections against mishandling of PHI throughout the workforce include provisions pertinent to physicaland technical safeguards taken in order to protect verbal, written and electronic PHI from being mishandled by workforce members as they execute their responsibilities. The following are examples of the types of uses and disclosures of your PHI that we are permitted to make without your authorization:
KS Plan Administrators LLC will use and disclose your PHI to administer your health benefits policy or contract, which may involve the determination of eligibility; claims payment; utilization review activities; medical necessity review; coordination of benefits and responding to complaints, appeals, and external review requests. Examples include:
KS Plan Administrators LLC may use and disclose your PHI for operational purposes. For example, your PHI may be disclosed to staff members within KS Plan Administrators LLC, such as medical-management, risk-management or quality-improvement personnel, and others to:
In addition, your PHI may be used for the following purposes, each of which is also considered health care operations:
KS Plan Administrators LLC may disclose your PHI to health care providers (doctors, dentists, pharmacies, hospitals and other caregivers) who request it in connection with your treatment. For example, for your safety, we may provide a list of medications you've received through your KS Plan Administrators LLC coverage to emergency room clinicians treating you in an effort to minimize the potential for adverse drug interactions. This information will only be furnished to emergency room clinicians with your consent, unless you are unable to provide consent. We may also disclose your PHI to health care providers in connection with preventive health initiatives, early detection programs, and disease management programs. For example, KS Plan Administrators LLC may disclose information to physicians involved in your care that includes a list of medications you've filled using your KS Plan Administrators LLC coverage (this will alert those physicians treating you to those medications prescribed for you by others and will help minimize potential adverse drug interactions). KS Plan Administrators LLC may also disclose information to your primary care physician to suggest a disease management or wellness program that could help improve your health.
At times, KS Plan Administrators LLC may contract with other organizations to provide services on our behalf. As these services are performed, PHI is accessed or disclosed. In these cases, KS Plan Administrators LLC will enter into an agreement explicitly outlining the requirements associated with the protection, use and disclosure of your PHI.
Examples of such "business associates" include behavioral health management companies and pharmacy benefit managers.
Other permitted or required uses and disclosures of PHI that do not require your authorization include the following:
To report information related to victims of abuse, neglect or domestic violence;
To assist law enforcement officials in performing their duties.
Uses and disclosures of PHI other than those listed above in Section II will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke such an authorization, at any time in writing, except to the extent that we have already taken an action based on a previously executed authorization.
If a written authorization is obtained from you, your PHI may be disclosed to your personal representative, a person (an adult or an emancipated minor) that KS Plan Administrators LLC recognizes as having the authority to act on behalf of another individual in making decisions related to health care. Many members ask us to disclose their PHI to third parties for reasons not described in this notice. For example, elderly members often ask us to make their records available to family members or caregivers. To authorize us to disclose any of your PHI to a person or organization for reasons other than those described in this notice, please call the toll free number on your ID card and you will be provided with the appropriate authorization form. You should send the completed form to our Member Services Department. You may revoke the authorization at any time by sending a letter to our Member Services Department at 11511 Shadow Creek Parkway, Pearland, TX 77584.
It is important for you to note that once you give us authorization to release your health information, the PHI that we release is out of KS Plan Administrators LLC’s control. KS Plan Administrators LLC is unable to safeguard such PHI from redisclosure by the person(s) that you have authorized us to release it to. Finally, KS Plan Administrators LLC will not use your PHI to offer you services or products unrelated to your health care coverage or your health status without your authorization.
The following are your rights with respect to your PHI.
You have the right to receive a copy of your PHI. We may ask you to request access to copies of your records in writing and to provide us with the specific information we need to fulfill your request. We reserve the right to charge a reasonable, cost-based fee for the cost of producing and mailing the copies of such information. We will endeavor to provide you the requested PHI within fifteen (15) business days of receipt of a complete written request and related fees. If we are using an electronic health records system capable of fulfilling the request, Texas law requires us to provide the requested records no later than the fifteenth (15th) business day after the date we receive your written request, and we must provide those records to you in electronic form unless you have agreed to accept the records in another form. There are certain cases in which we are not permitted to fulfill your request to access or receive your PHI.
You may not inspect or copy:
If you believe that your protected health information is incorrect or incomplete, you have the right to ask us to amend your PHI. All requests for amendment must be in writing. In certain cases, we may deny your request. For example, we may deny a request if we did not create the information, as is often the case for medical information that is generated by a provider and stored in our records, or if we believe the current information is correct. All denials will be made in writing within sixty (60) days of the original request. You may respond by filing a written statement of disagreement with KS Plan Administrators LLC and we would have the right to rebut that statement.
If you believe someone has received un-amended PHI from us, you should inform us at the time of the request if you want him or her to be informed of any amendment we may subsequently agree to execute.
KS Plan Administrators LLC recognizes that members have the right to receive communications regarding their PHI in a manner and at a location that the individual feels is safe from unauthorized use or disclosure. To support this commitment, KS Plan Administrators LLC will permit individuals to request that they receive PHI by alternative means or at alternative locations. We will consider and attempt to accommodate all reasonable requests, and we must agree to a request if you tell us you would be in danger if we do not. All requests must be in writing.
You have the right to request an accounting of those instances in which we have disclosed your PHI for six (6) years prior to the date of your request, who we shared it with, and why. All requests must be made in writing. KS Plan Administrators LLC will require you to provide us with the specific information we need to fulfill your request. We will provide one such accounting free of charge every twelve (12) months, but we may charge you a reasonable, cost-based fee for any additional accountings you request within that twelve-month period. We will include all disclosures except for the following:
You have the right to ask us to place restrictions on the way we use or disclose your PHI for treatment, payment, or health care operations, or as described in the section of this notice entitled “Other Permitted or Required Uses and Disclosures of PHI.” We are not, however, required by law to agree to these requested restrictions, and we may deny your request for a restriction if it would affect your care. If we do agree to a restriction, we may not use or disclose your PHI in violation of that restriction, unless it is related to an emergency. We may ask that you request these limits in writing.
You have a right to receive a paper copy of the Notice of Privacy Practices upon request at any time. You may be entitled to additional rights under state law.
To request a copy of this Notice of Privacy Practices at any time, or obtain additional information about this notice, you may contact:
KS Plan Administrators LLC
Member Services Department
11511 Shadow Creek Parkway
Pearland, TX 77584
or visit our website at www.kelseycareadvantage.com.
If you believe your privacy rights have been violated, you may file a written complaint with:
KS Plan Administrators LLC Health Care
11511 Shadow Creek Parkway
Pearland, TX 77584
or by contacting this office at 713-442-CARE (2273).
You may also notify the Secretary of the Department of Health and Human Services (HHS).
Send your complaint to:
Medical Privacy, Complaint Division, Office for Civil Rights (OCR)
United States Department of Health and Human Services,
200 Independence Avenue,
SW, Room 509F, HHH Building
Washington D.C, 20201
You may also contact OCR’s Voice Hotline Number at (800) 368-1019 or send the information to their Internet address www.hhs.gov/ocr/privacy/hipaa/complaints/.
KS Plan Administrators LLC will not take retaliatory action against you if you file a complaint about our privacy practices either with OCR or KS Plan Administrators LLC.
We may make a change to this notice and our privacy practices at any time, as long as the change is consistent with our current privacy policies or state or federal law. If we make an important change to our policies, we will promptly provide you with the new notice by mail and post it on our web site.
The effective date of this notice is April 1, 2007. Non-English speaking members may also call KS Plan Administrators LLC’s Member Services Department at 1-866-535-8343 to have their questions answered.
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