CCHP Notice of Privacy Practices
Effective Date: April 14, 2003
* Translation Disclaimer: This Notice is also provided in the Chinese language. If there is a discrepancy between the English version and the Chinese version, the English version shall control.
If you have any questions about this notice,
please contact the CCHP Privacy Officer at 415-397-3190.
Please be aware that this Notice may be updated from time to time.
INTRODUCTION
Chinese Community Health Plan, (CCHP) and its affiliated health care providers appreciate the opportunity to provide health care benefits to you and your family. In the course of providing the health benefit programs we administer or offer, CCHP must collect, use and disclose protected health information. We consider this information confidential and private and consequently, we have policies and procedures in place to protect the information against unlawful use and disclosure. In addition, we are required by law to:- Keep confidential your protected health information while providing for the uses and disclosures described here which are necessary to administer your health care benefits;
- Provide you with this Notice of our legal duties and privacy practices pertaining to your protected health information; and
- Abide by the terms of our privacy notice currently in effect.
What is Protected Health Information?
Protected Health information is information created or received by CCHP that identifies an individual applying for or enrolled in a health benefits program offered or administered by CCHP and relates to the person's participation in the program, the person's past, present or future physical or mental health condition, the provision of health care to that person, or payment for the provision of health care to that person. Protected health information does not include publicly available information or information that is available or reported in a summarized or aggregate fashion that does not identify any individual person.
What types of Protected Health Information do we collect?
In order to administer benefits and operate our programs, CCHP collects a variety of information about our members and their dependents including the following:
- Information we receive directly or indirectly from you, your employer or broker through enrollment forms, surveys or other forms, in writing, in person, by telephone or electronically including fax, email and the CCHP website (e.g. name, address, social security number, date of birth, marital status, dependent information, employment information, medical history) and;
- Information we collect from our affiliated health care providers, other health care providers and others regarding your health care services and your coverage (e.g. health care claims and encounters, medical history, eligibility information, payment information, and service authorization request, appeal and grievance information).
How we may use and disclose Protected Health Information
about you
The following categories describe different ways that we use and disclose protected health information. The examples given within each category are not meant to be exhaustive and not every use or disclosure will be listed within a category. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
For Treatment
We may use and disclose your protected health information for treatment. For example, we may disclose protected health information to your doctors, nurses, technicians, or other hospital/health care facility personnel who are involved in taking care of you. We may also disclose protected health information about you to people outside the hospital/healthcare facility who may be involved in your care after you are discharged.
For Payment
We may use and disclose protected health information in order to make payment for the health care services you receive, and to enable us to collect payment from others who may be responsible. For example, we may receive information about your treatment at Chinese Hospital and we will pay Chinese Hospital for the services you receive. Your Primary Care Physician or specialist may also tell us about a treatment you are going to receive in order to obtain prior authorization so that we will cover your treatment. If you are enrolled in CCHP as a dependent of another member (such as your spouse), we may disclose health information about you to that member for purposes of obtaining and administering payment.
For Health Care Operations
We may use and disclose protected health information about you for health care operations. In general, these uses and disclosures are activities necessary to run the health plan and make sure that all of our members receive quality care and include but are not limited to the following: quality assessments, performance reviews, underwriting and other activities related to renewing or replacing health insurance contracts, medical reviews, conducting or arranging for legal or auditing services, business planning and development and business management and administration. We may use protected health information to review our providers' treatment and services and to evaluate the performance of our staff in caring for you. We may also combine our members' information to decide what additional services the health plan should offer.
Treatment Alternatives
We may use and disclose protected health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Individuals Involved in Your care
We may release protected health information about you to a friend or family member who is involved with your care, unless you object. We may also disclose information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
As Required by Law
We will disclose protected health information about you when required to do so by federal, state or local law. For example, CHP must disclose your protected health information to the U.S. Department of Health and Human Services upon request for purposed of determining whether CCHP is in compliance with federal privacy law.
To Avert a Serious Threat to Health or Safety
We may disclose and use protected health information about you when necessary to prevent a serious threat to your health and safety, to protect the health and safety of the public or another person or to apprehend an individual.
SPECIAL SITUATIONS
Organ and Tissue Donation
If you are an organ donor, CCHP may disclose protected health information to the organization(s) that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to help organ or tissue donation and transplantation.
Military and Veterans
If you are a member of the armed forces, CHP may release protected health information about you as required by military command authorities or to the appropriate foreign military authority.
Workers' Compensation
CCHP may release protected health information about you for workers' compensation or similar programs.
Public Health Risks
We may disclose protected health information about you for public health activities. These activities generally include the following: to prevent or control disease, injury or disability; to report births and deaths; to report the abuse or neglect of children or the abuse, neglect or domestic violence against victims of any age ; to report reactions to medications or problems with products; to notify people of recalls of products they may be using; to notify a person who may have been exposed to a disease or be at risk of contracting or spreading a disease or condition; and to notify the appropriate government authority if we believe you have been the victim of abuse, neglect or domestic violence.
Disclosure to Employers
We may disclose protected health information to an employer if such information is needed to conduct an evaluation relating to medical surveillance of the workplace, or to evaluate whether the individual has a work-related illness or injury.
Health Oversight Activities
CCHP may disclose protected health information to a health oversight agency for activities authorized by law. These oversight activities include such activities as audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the health care system, government programs and compliance.
Lawsuits and Disputes
If you are involved in a lawsuit or dispute, CCHP may disclose protected health information about you in response to a court order or administrative disorder. We may also disclose information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute.
Law Enforcement
CCHP may release information to report crimes and certain injuries or if asked to do so by a law enforcement official: in response to a court order, summons, warrant, subpoena, administrative request or similar; to identify or locate a suspect, fugitive, witness or missing person; to report a crime, about a death that may be the result of criminal conduct or about criminal conduct at CCHP .
Coroners, Medical Examiners and Funeral Directors
CCHP may release protected health information to a coroner, funeral director or medical examiner in order to identify a deceased person, determine the cause of death, for other duties, or as required by law.
National Security and Intelligence Activities
CCHP may release protected health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities (including protective services for the president), authorized by law.
Inmates
If you are an inmate of a correctional institution or under the custody of a law enforcement official, CCHP may release information about you to the institution or to the official. This may be necessary to provide you with health care to protect your health and safety.
Business Associates
CCHP shares your protected health information with third party "business associates" that perform various administrative activities (such as billing) for CCHP. For example, CCHP contracts with another organization to handle our prescription drug program and process prescription drug claims. Whenever CCHP has an arrangement with a "business associate" that involves the use or disclosure of your protected health information, CCHP has a written contract that contains terms that will protect the privacy of your protected health information.
Whistleblowers and CCHP employee crime victims
CCHP employees may share your protected information to a health oversight agency, public health agency or lawyer authorized by the law to investigate or oversee CCHP.
OUR RIGHTS REGARDING PROTECTED HEALTH NFORMATION ABOUT YOU
You have the following rights regarding protected health information that we maintain about you:
Right to Inspect and Copy
You have the right to inspect and copy medical information that may be used to make decisions about your care. (Usually this includes medical and billing records but may not include some mental health information.)
To inspect and copy protected health information that may be used to make decisions about you, you must submit your request in writing to the CCHP Privacy Officer, c/o Chinese Community Health Plan, 445 Grant Avenue, Suite 700, San Francisico, CA 94108. If you request a copy of the information, CCHP may charge a fee for the costs of copying, mailing or other supplies associated with your request. We may also deny your request to inspect and copy in certain very limited circumstances (such as if access would cause harm). In other situations, we may deny your access, but if we do, we must provide you a review of our decision denying access. If we deny you access, we will explain why and what your rights are, including how to seek review. Detailed instructions for exercising your rights are available from the CCHP Privacy Officer, c/o Chinese Community Health Plan, 445 Grant Avenue, Suite 700, San Francisico, CA 94108.
Right To Amend
If you feel that the protected health information that CCHP has about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment if CCHP is the originator of the information . To request an amendment, your request must be made in writing and submitted to the CCHP Privacy Officer c/o Chinese Community Health Plan, 445 Grant Avenue, Suite 700, San Francisico, CA 94108. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, CCHP may deny your request to amend, if:
- CCHP was not the person or entity that created the information,
- is not part of the information which you would be permitted to inspect and copy; or
- is accurate and complete. If we deny your request for amendment/correction, CCHP will notify you why, how you can attach a statement of disagreement to your records (which we may rebut), and how you can complain.
Right to an Accounting of Disclosures
You have the right to request an "accounting of disclosures." This is a list of the non-routine disclosures CCHP has made of your protected health information about you OTHER than for treatment, payment and health care operations as described previously. (For example, CCHP does not have to provide you with an accounting of disclosures of protected health information already given to you, disclosures for national security or intelligence purposes, or to correctional institutions or law enforcement officials that do not require authorization or an opportunity for you to object or incident to any otherwise permitted use or disclosure.)
To request this list or accounting of disclosures, you must submit your request in writing to: CCHP Privacy Officer c/o Chinese Community Health Plan, 445 Grant Avenue, Suite 700, San Francisico, CA 94108. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper or on computer file). CCHP must provide the list or accounting of disclosures within 60 days from receipt. The accounting of disclosures must include the following information: the date of each disclosure, the name and address or the organization or person who received the protected health information and a brief description of the information disclosed. The first list you request within a 12-month period will be free. For additional lists, CCHP may charge you the costs of providing the list. CCHP will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions
You have the request to request a restriction or limitation on the protected health information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the information we disclose about you to someone who is involved in your care or payment for your care, like a family member or friend. For example, you could ask that CCHP not disclose information about a surgery you had to a family member. The right to request restrictions do not apply to requests where uses or disclosures are required by law.
If the request is appropriate, CCHP is not required to agree to your request. If we do agree, we will comply with your request unless you request otherwise, we give you advance notice to terminate the restriction or the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing to: CCHP Privacy Officer c/o Chinese Community Health Plan, 445 Grant Avenue, Suite 700, San Francisico, CA 94108. In your request, you must tell us what information you want to limit; whether you want to limit our use, disclosure or both; and to whom you want the limits to apply (for example, not tell your spouse or children).
Right to Request Confidential Communications
You have the right to request that CCHP communicates with you about matters in a certain way or at a certain location. For example, you may ask that CCHP contact you at work or bymail.
To request confidential communications, you must make your request in writing to: CCHP Privacy Officer c/o Chinese Community Health Plan, 445 Grant Avenue, Suite 700, San Francisico, CA 94108. CCHP will not ask you for the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of this Notice
You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you receive this notice electronically, you are still entitled to receive a paper copy of this notice. You may obtain a copy of this notice at our website, www.cchphmo.com. To obtain a paper copy of this notice, please contact our Member Services Department, 415-397-3190.
Right to Receive a Revised Notice
CCHP reserves the right to revise our privacy practices as necessary. If and when changes are made, CCHP will send you a revised Notice within 60 days of any material revision to this Notice.
State Law Limitations
In some circumstances, your protected health information may be subject to restrictions that may limit or preclude some uses or disclosures above. For example, government health benefit programs may limit the disclosure of members' health information for purposes unrelated to the program. In addition, there are special restrictions on the disclosure of health information relating to HIV/AIDS status, mental health treatment, developmental disabilities, and drug and alcohol abuse treatment. CCHP complies with these restrictions in our use of your protected health information.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with CCHP or with the Secretary of the Department of Health and Human Services. To file a complaint with CCHP, contact: CCHP Privacy Officer c/o Chinese Community Health Plan, 445 Grant Avenue, Suite 700, San Francisico, CA 94108 or call 415-397-3190 x 350. All complaints must be submitted in writing.
YOU WILL NOT BE PENALIZED FOR FILING A COMPLAINT.
OTHER USES OF PROTECTED HEALTH INFORMATION
Other uses and disclosures of protected health information not covered by this notice or the laws that apply to CCHP will be made only with your written permission. If you provide us permission to use or disclose protected health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose protected health information about your for the reasons covered by your written authorization. Your understand that CCHP is unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.