Healthcare Interactive, Inc dba HCIactive values you as a customer, and protection of your privacy is very important to us. In conducting our business, we
will create and maintain records that contain protected health information about you.
Please note that the following terms will only apply based on the programs and services selected by the employer group.
“Protected Health Information” or “PHI” is information about you, including demographic information such as your name, address and social
security number, that can reasonably used to identify you and that relates to your past, present or future physical or mental health
condition, the provision of health care to you, or the payment for that care.
means any information, whether oral or recorded in any form or medium, that–
(A) is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university,
or health care clearinghouse; and
(B) relates to the past, present, or future physical or mental health or condition of any individual, the provision of health care to an
individual, or the past, present, or future payment for the provision of health care to an individual.”
“Individually identifiable health information is information that is a subset of health information, including demographic
information collected from an individual, and:
(1) Is created or received by a health care provider, health plan, employer, or health care clearinghouse; and
(2) Relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an
individual; or the past, present, or future payment for the provision of health care to an individual; and
(i) That identifies the individual; or
(ii) With respect to which there is a reasonable basis to believe the information can be used to identify the individual.”
We protect your privacy by:
· Limiting who may see your PHI;
· Limiting how we may use or disclose your PHI;
· Informing you of our legal duties with respect to your PHI;
· Explaining our privacy policies;
· Adhering to the policies currently in effect.
This Notice describes our privacy practices, which include how we may use, disclose, collect, handle and protect our members’ protected
health information. We are required by certain federal and state laws to maintain the privacy of your protected health information. We also
are required by the federal Health Insurance Portability and Accountability Act (or “HIPAA”) Privacy Rule to give you this Notice about our
privacy practices, or legal duties, and your rights concerning your protected health information.
This Notice takes effect on April 14, 2003, and will remain in effect until we replace or modify it.
Copies of this Notice
You may request a copy of our Notice at any time. If you want more information about our privacy practices, or have questions or concerns,
please contact HCIactive by calling (888)236-8581, or emailing email@example.com
, or writing to us using the contact information at the end of this notice.
Changes to this Notice
The terms of this Notice apply to all records that are created or retained by us which contain your PHI. We reserve the right to revise or
amend the terms of this Notice. A revised or amended Notice will be effective for all of the PHI that we already have about you, as well as
for any PHI we may create or receive in the future. We are required by law to comply with whatever Privacy Notice is currently in effect.
You will be notified of any material change to our Privacy Notice before the change becomes effective. When necessary, a revised Notice
will be mailed to the address that we have on record for the contract holder of your member contract.
Potential Impact of State Law
The HIPAA Privacy Rule generally does not “preempt” (or take precedence over) state privacy or other applicable laws that provide
individuals greater privacy protections. As a result, to the extent state law applies, the privacy laws of a particular state, or other
federal laws, rather than the HIPAA Privacy Rule, might impose a privacy standard under which we will be required to operate. For example,
where such laws have been enacted, we will follow more stringent state privacy laws that relate to uses and disclosures of the protected
health information concerning HIV or AIDS, mental health, substance abuse/chemical dependency, genetic testing, reproductive rights, etc.
How We May Use and Disclose Your Protected Health
In order to administer our health benefit programs effectively, we will collect, use and disclose PHI for certain of our activities,
including payment of covered services, wellness services and health care operations.
The following categories describe the different ways in which we may use and disclose your PHI. Please note that every permitted use or
disclosure of your PHI is not listed below. However, the different ways we may use or disclose your PHI do fall within one of the permitted
categories described below.
We may use and disclose your PHI for all payment activities including, but not limited to, collecting premiums or to determine or fulfill
our responsibility to provide prescription drug coverage under your health plans. This may include coordinating benefits with other health
care programs or insurance carriers. For example, we may use and disclose your PHI to pay claims for services provided to you under your
prescription drug plan(s), or to determine if requested services are covered under your prescription drug plan.
Treatment: We may use or disclose your PHI to facilitate medical treatment by providers. For example, your PHI may be
provided for a physician to whom you have been referred to ensure that the physician has the necessary information to treat you. We may
request the services of a business associate to assist us in these activities. Any business associate we may employ will be covered under a
Business Associate Agreement.
Health Care Operations:
We may use and disclose your PHI to provide health care services to you, or to coordinate and consult with other health care providers in
treating you or providing health care and related services to you. For example, to assist you with a problem you may be having with a
pharmacy, we may need to discuss information about your health with the pharmacist to ensure that the prescribed drug is being processed
We may use and disclose your PHI to bill and collect payment from you, your health plan or a third party, for the treatment or services you
receive. For example, we may need to provide information about the prescription drugs filled for you, to your health plan, so that they
will pay us or reimburse you for these drugs.
We may also use and disclose your PHI to conduct quality assessment and improvement activities, to conduct business planning activities, to
conduct fraud detection programs, to conduct or arrange for medical review, or to engage in coordination of health care services.
We may also use and disclose your PHI to certain contractors we ask to help us provide services to you or to operate our business. For
example, we may ask a contractor to send out refill reminders on our behalf, or an accounting firm to audit our books and records. We will
require these contractors to agree in writing to protect the privacy of any health information they receive in order to perform their
We may also use and disclose your PHI to offer you one of our value added programs such as discounted health-related services, or to
provide you with information about one of our disease management programs or other available HCIactive products or services.
We may also use and disclose your PHI to provide you with reminders to obtain preventive health services, and to inform you of treatment
alternatives and/or health related benefits and services that may be of interest to you.
Release of Information to Plan Sponsors:
Plan sponsors are employers or other organizations that sponsor a group health plan. We may disclose PHI to the plan sponsor of your group
health plan as follows:
· We may disclose “summary health information” to your plan sponsor to use to obtain premium bids for providing prescription drug coverage
or to modify, amend or terminate its group health plan. “Summary Health Information” is information that summarizes claims history, claims
expenses, or types of claims experience for the individuals who participate in the plan sponsor’s group health plans;
· In compliance with Affordable Care Act (ACA) rules, we may disclose to your plan sponsor certain PHI in accordance with the coordination
of premiums and incentives, as well as enrollment and disenrollment, as it pertains to the wellness program.
· We may disclose your PHI to the third party administrator of your group health plan so that the third part administrator can administer
the group health plan;
· If you are enrolled in a group health plan, your plan sponsor may have met certain requirements of the HIPAA Privacy Rule that will
permit us to disclose PHI to the plan sponsor. Sometimes the plan sponsor of a group health plan is the employer. An employer may have a
“Privacy Officer” designated and the “Privacy Officer” is allowed, by law, to have access to PHI. You should talk to your employer to find
out how this information will be used.
Required by Law:
We may disclose your PHI when required to do so by applicable law. For example, the law requires us to disclose your PHI:
When required by the Secretary of the U.S. Department of Health and Human Services to investigate our compliance efforts; and
To health oversight agencies, to allow them to conduct audits and investigations of the health care system, to determine eligibility for
government programs, to determine compliance with government program standards, and for certain civil rights enforcement actions.
Public Health Activities:
We may disclose your PHI to public health agencies for public health activities that are permitted or required by law, such as to:
· Prevent or control disease, injury or disability;
· Maintain vital records, such as births and deaths;
· Report child abuse and neglect;
· Notify a person about potential exposure to a communicable disease;
· Notify a person about a potential risk for spreading or contracting a disease or condition;
· Report reactions to drugs or problems with products or devices;
· Notify individuals if a product or device they may be using has been recalled; and
· Notify appropriate government agency(ies) and authority(ies) about the potential abuse and neglect of an adult patient, including
Health Oversight Activities:
We may disclose your PHI to a health oversight agency for activities authorized by law, such as: audits, investigations; inspections;
licensure of disciplinary actions; or civil; administrative, or criminal proceedings or actions. Health oversight agencies seeking this
information include government agencies that oversee: (i) the health care system; (ii) government benefit programs; (iii) other government
regulatory programs; and (iv) compliance with civil rights laws.
Lawsuits and Other Legal Disputes:
We may disclose your PHI in response to a court or administrative order, subpoena, discovery request, or other lawful process once we have
met all administrative requirements of the HIPAA Privacy Rule.
We may disclose your PHI to law enforcement officials under certain conditions. For example, we may disclose your PHI:
· To permit identification and location of witnesses, victims and fugitives;
· In response to a search warrant or court order;
· As necessary to report a crime on our premises;
· To report a death that we believe may be the result of criminal conduct;
· In an emergency, to report a crime.
Coroners, Medical Examiners or Funeral Directors:
We may release PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or to determine the
cause of death. We also may disclose, as authorized by law, information to funeral directors so that they may carry out their duties.
To Prevent a Serious Threat to Health or Safety:
As permitted by law, we may disclose your PHI if we believe that the disclosure is necessary to prevent or lessen a serious and imminent
threat to the safety of a person or the public.
Military and National Security:
We may disclose to military authorities the PHI of Armed Forces personnel under certain circumstances. We may disclose to authorized
federal officials PHI required for lawful intelligence, counter-intelligence, and other national security activities.
As part of your workers’ compensation claim, we may have to disclose your PHI to a workers’ compensation carrier.
Certain aspects and components of our business are performed through contracts with outside persons or organizations. Examples of these
outside persons and organizations include duly appointed insurance agents, third party administrators, licensed auditors, actuarial and
underwriting services, reinsurers, legal services, enrollment and billing services, claim payment and medical management services and
collection agencies. At times it may be necessary for us to provide your PHI to one or more of these outside persons or organizations who
assist us with our payment of health care operations. In all cases, we require these business associates to appropriately safeguard the
privacy of your information.
When you ask us to, we will disclose to you your PHI. Generally, this will include medical, enrollment, claims and billing records we may
have about you, as well as other records that we use to make decisions about your health care benefits. You can request your PHI as
described in the section called “Your Privacy Rights Concerning Your Protected Health Information.”
To Your Personal Representative:
If you tell us to, we will disclose your PHI to someone who is qualified to act as your personal representative according to any relevant
state laws. In order for us to disclose your PHI to your personal representative, you must complete a HCIactive Personal
Representative Designation Form. The HCIactive Personal Representative Designation Form is available electronically within the
To Family and Friends:
Unless you object, we may disclose your PHI to a friend or family member who has been identified as being involved in your health care. We
also may disclose your PHI to an entity assisting in a disaster relief effort so that your family can be notified about your condition,
status, and location. If you are not present or able to agree to these disclosures of your PHI, then we may, using our professional
judgment, determine whether the disclosure is in your best interest.
Parents as Personal Representatives of Minors:
In most cases, we may disclose your minor child’s PHI to you. However, we may be required to deny a parent’s access to a minor’s PHI
according to applicable state law.
Right to Provide an Authorization for Other Uses and Disclosures
Other uses and disclosures of your PHI that are not described above will be made only with your written authorization. You may give us
written authorization permitting us to use your PHI or disclose it to anyone for any purpose. We will obtain your written authorization for
uses and disclosures of your PHI that are not identified by this Notice, or are not otherwise permitted by applicable law.
Any authorization that you provide to us regarding the use and disclosure of your PHI may be revoked by you in writing at any time. After
you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization. Of course, we are
unable to take back any disclosures that we have already made with your authorization. We may also be required to disclose your PHI for
purposes of payment for services received by you prior to the date when you revoke your authorization.
Your authorization must be in writing, or in some cases may be authorized electronically, and contain certain elements to be considered a
Your Privacy Rights Concerning Your Protected Health Information (PHI)
You have the following rights regarding the PHI that we maintain about you. Requests to exercise your rights as listed below must be in
writing. Please contact a Navigator at the telephone number listed at the bottom of this form, or write to us at the address listed at the
end of this Notice.
Right to Access Your PHI:
You have the right to inspect or get copies of your PHI. Generally, this will include medical, enrollment, claims and billing records we
may have about you, as well as other records that we use to make decisions about your health care benefits.
You may request that we provide copies of your PHI in a format other than photocopies. We will use the format you request unless we cannot
practicably do so. We may charge a reasonable fee for copies of PHI (based on our costs), for postage, and for custom summary or
explanation of PHI. You will receive notification of any fee(s) to be charged before we release your PHI, and you will have the opportunity
to modify your request in order to avoid and/or reduce the fee. In certain situations we may deny your request for access to your PHI. If
we do, we will tell you our reasons in writing, and explain your right to have the denial reviewed.
Right to Amend Your PHI:
You have the right to request that we amend your PHI if you believe there is a mistake in your PHI, or that important information is
missing. Approved amendments made to your PHI will also be sent to those who need to know, including (where appropriate) Healthcare
Interactive’s vendors (known as “Business Associates”). We may also deny your request if, for instance, we did not create the information
that you want amended. If we deny your request to amend your PHI, we will tell you our reasons in writing, and explain your right to file a
written statement of disagreement.
Right to Accounting of Certain Disclosures:
You may request, in writing, that we tell you when we or our Business Associates have disclosed your PHI (an “Accounting”). Any accounting
of disclosures will not include those we made:
· For payment, or health care operations;
· To you or individuals involved in your care;
· With your authorization;
· For national security purposes; or before September 15, 2014.
The first accounting in any 12-month period is without charge. We may charge you a reasonable fee (based on our cost) for each subsequent
accounting request within a 12-month period. If a subsequent request is received, we will notify you of any fee to be charged, and we will
give you an opportunity to withdraw or modify your request in order to avoid or reduce the fee.
Right to Request Restrictions:
You have the right to request, in writing, that we place additional restrictions on our use or disclosure of your PHI. We are not required
to agree to your request. However, if we do agree, we will be bound by our agreement except when required by law, in emergencies, or when
information is necessary to treat you. An approved restriction continues until you revoke it in writing, or until we tell you that we are
terminating our agreement to a restriction.
Right to Request Confidential Communications:
You have the right to request, in writing, that we use alternate means or an alternate location to communicate with you in confidence about
your PHI. For instance, you may ask that we contact you by mail, rather than by telephone, or at work, rather than at home. Your written
request must clearly state that the disclosure of all or part of your PHI at your current address or method of contact we have on record
could be an endangerment to you. We will require that you provide a reasonable alternate address or other method of contact for the
confidential communications. In assessing reasonableness, we will consider our ability to continue to receive payment and conduct health
care operations effectively, and the subscriber’s right to payment information. We may exclude certain communications that are commonly
provided to all members from confidential communications. Examples of such communications include booklets and newsletters.
Right to a Paper Copy of This Notice:
You have the right to receive a paper copy of our Notice of Privacy Practices. You can request a copy at any time. To request a paper copy
of this Notice, please contact a Navigator at the telephone number at the bottom of this document.
Your Right to File a Privacy Complaint
If you believe your privacy rights have been violated, or if you are dissatisfied with HCIactive’s privacy practices or
procedures, you may file a complaint with the HCIactive’s Privacy Office and with the Secretary of the U.S. Department of
Health and Human Services. You will not be penalized for filing a complaint.
To file a privacy complaint with us, you may contact HCIactive’s Privacy Officer as follows:
HCIactive – Privacy Officer
3060 Route 97, Suite 200, Glenwood, MD 21738
Phone: (888)236-8581 firstname.lastname@example.org