A. Notice of Privacy Practices
B. Authorization Form to Disclose Protected Health Information
A. UMWA Health and Retirement Funds’ 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.
The Funds is required by law to:
- Make sure that medical and payment information that identifies you is kept private;
- Give you this Notice about our legal duties and privacy practices with respect to medical and payment information about you; and
- Follow the terms of the Notice that is currently in effect.
I. HOW WE MAY USE AND DISCLOSE MEDICAL & PAYMENT INFORMATION ABOUT YOU
The Funds uses and discloses medical and payment information for many different reasons.
Below, we describe the different categories of our uses and disclosures and give you some examples of each category. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
1. For Treatment. The Funds will use and disclose your medical information as needed to coordinate or manage your medical care and any related services. This includes the coordination or management of your medical care with a Funds’ third party “Business Associate.” For example, we may disclose your medical information to refer you to a Funds’ program for managing diabetes or heart disease. We may disclose your medical information to a durable medical equipment company to provide equipment or supplies to you. We may also disclose your medical information to a local agency to provide home health services or meal services. We may disclose your information to local community resources to connect you with appropriate assistance to help you in your efforts to stay healthy and independent.
2. Payment. Your medical information will be used, as needed, to provide payment for your health care services. This may include determining your eligibility and coverage for health services, reviewing services provided to you to determine if they were medically necessary, and performing utilization review activities, such as pre-approving services before you receive them.
For example, the Funds may review your eligibility information to determine what your Fund benefits are. We may use your medical information to approve a hospital or nursing home stay. The Funds may also use your medical and payment information to obtain payment from responsible third parties.
3. Healthcare Operations. The Funds may use or disclose, as needed, your medical or payment information in order to support the business activities of the Funds’ health benefit plans. For example, we may use your claims payment records to review the quality of our claims payment operations. We may also provide your claims payment information to our accountants, attorneys, consultants and others as necessary to make sure we are complying with the laws that affect us.
4. Health-Related Benefits and Services. We may use and disclose medical and payment information about you to tell you about health-related benefits or services that may be of interest to you. For example, we may use your medical and payment information to inform you about flu shot clinics, transportation services such as van services, or health fairs. Your information may be used to ensure that the proper medications are being prescribed, that emergency room visits are the appropriate level of care, and that nursing home care is medically necessary and should be utilized. We may also use your information to determine if your medical conditions put you at risk for maintaining your health and independent living.
5. As Required by Law. We will use or disclosure your medical and payment information when required to do so by federal, state or local law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures.
6. For Public Health Activities. We may disclose your medical and payment information for public health activities to a public health authority that is permitted by law to collect or receive such information.
For example, we may notify the appropriate government authority to report child abuse and neglect or if we believe you have been the victim of abuse, neglect, or domestic violence. We will only release this information if you agree, or if the disclosure is required by law, or if the disclosure is authorized by law and necessary to prevent serious harm to you or other potential victims.
7. For Health Oversight Activities. We may disclose medical and payment information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. These activities are necessary for the government to monitor the health care system, compliance with civil rights laws, and government programs such as Medicare. For example, we will provide information to assist the government when it conducts an investigation or inspection of a health care provider or organization. We may disclose medical and payment information to assist government programs in their study and development of programs for senior citizens.
8. For Law Enforcement: We may disclose medical and payment information for law enforcement purposes as required by law or in response to a court or administrative order, subpoena, discovery request or other lawful process.
9. To Individuals Involved in your Care or Payment for your Care. Unless you object, we may release or discuss your medical and payment information to a family member, relative, friend, or any other person that you identify who is involved in your care or the payment for your health care. We may also use or disclose medical and payment information to notify or assist in notifying your family or friends about your general condition, location, or death. We may disclose this information to help in assisted living arrangements, nursing home benefits, additional Funds benefits, and estate planning.
If you are unable to agree to or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment.
10. To the Funds’ Trustees. We may disclose medical and payment information to the Funds’ Trustees as required to administer the Funds’ health plans.
11. To Avoid Harm. We may use and disclose medical and payment information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure would only be to someone able to prevent the threat, such as law enforcement personnel.
12. For Disaster Relief Efforts. We may disclose medical information about you to an authorized organization assisting in a disaster relief effort so your family can be notified about your condition, status, and location. We may disclose information to assist in the replacement of durable medical equipment, pharmacy medication, and transportation.
13. For Workers’ Compensation Purposes. We may provide medical and payment information in order to comply with workers’ compensation laws.
ALL OTHER USES AND DISCLOSURES REQUIRE YOUR PRIOR WRITTEN AUTHORIZATION
In any other situation not described above, we will ask for your written permission before using or disclosing any of your medical and payment information. If you choose to sign an authorization to disclose your medical and payment information, you can revoke that authorization at any time in writing. This will stop any future uses and disclosures to the extent that we haven’t taken any action based on the authorization.
II. YOUR RIGHTS REGARDING YOUR HEALTH AND PAYMENT INFORMATION
You have the following rights:
A. The Right to See and Get Copies of Your Medical and Payment Information.
In most cases, you have the right to look at or get copies of your medical and payment information held by the Funds. You must request this information in writing. We will respond within 30 days of receiving your request.
In certain situations, we may deny your request. If we do, we will tell you in writing our reasons for the denial and explain your right to have the denial reviewed.
B. The Right to Request Limits on the Uses and Disclosures of your Medical and Payment Information for Healthcare Operations Purposes.
You have the right to ask that we limit how we disclose your information so long as the restrictions do not interfere with the Funds’ ability to perform treatment, payment, and health care operations. Restrictions may include asking that we limit how we disclose your information to persons you identify. You may not limit the uses and disclosures that we are legally required or allowed to make.
Your written request must state the specific restriction requested and to whom you want the restriction to apply. We will consider your request, though we are not legally required to accept it. We will try to comply with your wishes that do not impede our operations. If we accept your request, we will put any limits in writing and abide by them except in emergency situations.
C. The Right to Choose How We Send Medical and Payment Information to You
You have the right to ask that we send information to you to a different address such as a relative’s or work address or by an alternate means, such as by telephone instead of regular mail. Your request must be in writing. We must agree to your request so long as we can reasonably provide it in the format you requested.
D. The Right to Get a List of the Disclosures We Have Made
You have the right to get a list of instances in which we have disclosed your medical or payment information. The list will not include uses or disclosures made for treatment, payment or health care operations, those made directly to you or to your family, or those that you authorized. The list also will not include disclosures made for national security purposes, to corrections or law enforcement personnel, or before April 14, 2003.
We will respond within 60 days of receiving your request. The list we will give you includes disclosures made in the last six years unless you request a shorter time. The list will include the date of disclosure, to whom the information was disclosed (including their address if known), and the reason for the disclosure. We will provide the list to you at no charge.
E. The Right to Correct or Update Your Funds’ Medical and Payment Information
If you believe that there is a mistake in your medical or payment information or that a piece of important information is missing, you have the right to request that we correct the existing information or add the missing information. You must provide the request and your reason for the request in writing. We will respond within 60 days of receiving your request.
We may deny your request in writing if the information is (i) correct and complete, (ii) not created by us, (iii) not allowed to be disclosed, or (iv) not part of our records. Our written denial will state the reasons for the denial and explain your right to file a written statement of disagreement with the denial. If you do not file one, you have the right to request that your request and our denial be attached to all future disclosures of your PHI.
If we approve your request, we will make the change to your information, tell you that we have done it, and tell others that need to know about the change.
F. The Right to Get This Notice by E-Mail
You have the right to get a copy of this notice by e-mail. Even if you have agreed to receive a notice via e-mail, you also have the right to request a paper copy of this notice.
III. CHANGES TO THIS NOTICE
The Funds reserves the right to change the terms of this notice and our privacy policies at any time. Any changes will apply to the information we already have as well as any information we receive in the future. The Funds will send a revised copy of the Notice to Funds ‘ beneficiaries within sixty (60) days of the material revision.
IV. HOW TO EXERCISE YOUR RIGHTS
You may call the Funds’ Health Call Center at 1-800-291-1425 for assistance. The Health Call Center will help you determine when you need to file a written request and provide you with the correct form and instructions.
V. HOW TO COMPLAIN ABOUT OUR PRIVACY PRACTICES
If you think we have violated your privacy rights, or you disagree with a decision we made about access to your medical and payment information, you may file a complaint with the Funds’ Privacy Officer. You also may send a written complaint to the Secretary of the Department of Health and Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20201. We will take no retaliatory action against you if you file a complaint about our privacy practices.
VI. PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR TO COMPLAIN ABOUT OUR PRIVACY PRACTICES
If you have any questions about this notice or any complaints about our privacy practices, contact the Funds’ Privacy Officer at:
Privacy Officer
UMWA Health & Retirement Funds
2121 K St. NW, Suite 350
Washington, D.C. 20037
202-521-2200
You may also contact the Privacy Officer to find out how to file a complaint with the Secretary of the Department of Health and Human Services.
VII. EFFECTIVE DATE OF THIS NOTICE
This notice went into effect on April 14, 2003.
B. Beneficiary Authorization Form to Disclose Protected Health Information
The UMWA Health and Retirement Funds (the “Funds”) is prohibited by law from disclosing your protected health information, except for purposes of treatment, payment and health care operations activities. The enclosed Authorization for the Use and Disclosure of Protected Health Information will permit the Funds to use or disclose some of your protected health information. In general, the Funds may not disclose your protected health information to your spouse, family members, friends or others, unless the individual receiving the health information is your personal representative. By completing the attached authorization you can tell the Funds to whom we may release your health information. You are not required to complete this form or to authorize others to have access to your health information.
If you choose to complete the authorization form, please be sure to complete all sections. If you have given someone power of attorney or have a legal guardian, we will give that person access to your health information if we receive a copy of the legal documents describing your personal representative’s authority to act on your behalf. The authorization form should be sent to:
UMWA Funds Call Center
PO Box 2320
Beckley, WV 25802-2320
If you need additional copies of the authorization form or have any questions, please contact the Funds Health Call Center at 1-800-291-1425.
Authorization Form to Disclose Protected Health Information(PDF)
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