PHI stands for these words, protected health information. PHI means health information that includes your name, member number or other identifiers, and is used or shared by University Health Plans.
Our Organization This notice describes the privacy practices of the Healthy Advantage (HMO) Medicare insurance program. Healthy Advantage (HMO) Medicare is an included health plan administered by the University of Utah. Affiliated providers are not employed by Healthy Advantage (HMO) Medicare but have a contractual relationship with Healthy Advantage (HMO) Medicare. For more information about the privacy practices of University of Utah Health Sciences Center (UUHSC) providers and affiliated providers, please contact them directly or visit the University Privacy Office.
Privacy Promise Healthy Advantage (HMO) Medicare understands that your PHI is personal and protecting your PHI is important. We will not share your medical information except as described in this notice. This notice applies to all of the medical information we collect to provide you with insurance.
Uses & Disclosures of Health Information Permitted by Law Healthy Advantage (HMO) Medicare will not disclose your PHI unless we are allowed or required by law to make the disclosure, or if you (or your authorized representative) give us permission. Uses and disclosures, other than those listed below, require your authorization. If there are other legal requirements under applicable state laws that further restrict our use or disclosure of your PHI, we'll comply with those legal requirements as well.
Examples of Disclosure for Treatment, Payment and Health Care Operations
The following categories describe the ways that Healthy Advantage (HMO) Medicare may use and disclose your PHI. Some health records, including confidential communications with a mental health professional, some substance abuse treatment records, some genetic test results, and some health information of minors, may have additional restrictions for use and disclosure under state and federal laws.
Treatment: We may use and disclose your PHI for our treatment activities or for the treatment activities of a health care provider. Treatment activities include disclosing your PHI to a provider in order for that provider to treat you.
Payment: We may use and disclose your PHI for our payment activities, including the payment of claims from physicians, hospital and other providers for services delivered to you.
Plan Operations: When you enroll or renew the consent provided on your enrollment application allows Healthy Advantgage Medicare and its business associates to collect, maintain, use and share your PHI to provide service to members, manage our business, or conduct related activities. For example, this includes educational purposes, quality assurance, audits, certification, or licensing.
Health Care Operations: We may use or disclose your PHI for our internal operations, including our customer service activities. For example, we may use your PHI to evaluate the timeliness of processing of claims submitted for our subscribers.
Required by Law: We must disclose your PHI when we are required to do so by law.
Public Health or Safety: We may disclose your PHI if we believe disclosure is necessary to avert a serious and imminent threat to your health or safety or the health or safety of others. We may disclose your PHI to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, domestic violence or other crimes.
Business Associates: We may also share your PHI with third party "business associates" who perform certain activities for us. Examples include copy services, consultants, interpreters, and auditors. We require these business associates to afford your PHI the same protections afforded by us.
Plan Sponsors: If you are enrolled in a group health plan, we may disclose your PHI to the plan sponsor to permit it to perform administrative activities.
Underwriting: We may receive, use and disclose your PHI for underwriting, premium rating or other activities relating to the creation, renewal or replacement of a contract of health insurance or health benefits.
To You or Your Authorized Representative: Upon your request, we'll disclose your PHI to you or your authorized representative. If you authorize us to do so, we may use your PHI or disclose it to the person or entity you name on your signed authorization. You may revoke your authorization in writing at any time. Your revocation won't affect any use or disclosures permitted by your authorization while it was in effect.
Individuals Involved In Your Care or Payment for your Care: We may disclose your PHI to a spouse, family member, close personal friend, or any individual identified by you. You will have the opportunity to identify this person or to object to our disclosing information to them. We may also disclose to them if we can reasonably infer from you that you do not object to the disclosure. We will only do so if we determine that the disclosure is in your best interest.
Research: Under certain limited circumstances, Healthy Advantage (HMO) Medicare may use or disclose PHI about you for research after the University's Institutional Review Board (IRB) has approved the research proposal. The IRB is a committee that reviews all research at the University involving patients to protect patients and their privacy.
Fundraising: Healthy Advantage (HMO) Medicare does not send fundraising mailings, but you may receive fundraising mailings from the UUHSC. The UUHSC is a charitable institution with a three-fold mission of patient care, research, and teaching. To further this mission, we may wish to contact you occasionally for fundraising purposes. If you do not wish to be contacted for this purpose, please notify the UUHSC Development office in writing at 50 North Medical Drive, Salt Lake City, UT 84132.
Health Care Communications: To identify health-related services and products that may benefit you and then contact you about the services and products.
Death; Organ Procurement Organizations: We may disclose the PHI of a deceased person to a coroner, medical examiner, or funeral director. To the extent allowed by law, we may disclose your PHI to organ procurement organizations and other entities engaged in the procurement, banking or transplantation of organs for the purpose of tissue donation and transplant. For example, Healthy Advantage (HMO) Medicare is required to disclose a positive communicable disease test result before or after transplantation to the medical director or executive director of the organ procurement organization and the United Network for Organ Sharing ("UNOS"), pursuant to UNOS regulations.
Public Health Activities: Healthy Advantage (HMO) Medicare may use or disclose your PHI with public health authorities in charge of preventing or controlling disease, injury, or disability. For example, Healthy Advantage (HMO) Medicare is required to report infectious diseases to the Utah Department of Health; claims practices may be audited by the Utah State Auditor; and records are subject to review by the Secretary of Health and Human Services. We may also disclose your PHI to reduce or prevent a serious threat to public health and safety.
Workers Compensation: Healthy Advantage (HMO) Medicare may use or disclose PHI about you for workers' compensation or similar programs that provide benefits for work-related injuries or illnesses.
Health Oversight Activities: To a health oversight agency that oversees the health care system and ensure compliance with the rules of government health programs such as Medicare or Medicaid.
Judicial and Administrative Proceedings: In the course of a judicial or administrative proceeding in response to a legal order, court order, administrative order, or other lawful purpose.
Law Enforcement Officials; Specialized Government Functions: We may disclose information to the police or other law enforcement officials as required by law or in compliance with a court order. We may disclose information to military or veterans' authorities about Armed Forces personnel, under certain circumstances. We may also disclose information to authorized federal officials for purposes of lawful intelligence, counterintelligence, and other national security activities.
Decedents: To a coroner, medical examiner, or funeral director as authorized by law.
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Your Individual Rights
You have the following rights concerning your PHI. A request
to exercise any of these rights must be made in writing.
Please call Customer Service at 1-877-644-0344
(TDD/TTY 1-800-346-4128) 8:00 a.m. - 8:00 p.m., Monday through Friday for assistance on obtaining the forms or filling out the forms. Forms are also available on the Internet at www.compliance.utah.edu/forms/forms-healthplan.html
- Right to Alternative Communications: You have the right to request Healthy Advantage (HMO) Medicare communicate with you in a certain manner. For example, you may ask that Healthy Advantage (HMO) Medicare contact you only at work or at a different address than your home address.
- Right to Inspect or Receive Copy: You have the right to inspect or receive a copy your PHI.
- Right to Amend:You have the right to request an amendment to your PHI.
- Right to an Accounting: You have the right to request an accounting of certain disclosures of your PHI made by us. The list does not include disclosures made for treatment, payment, and health care operations and some disclosures required by law. Your request must state the period of time requested for the accounting. An accounting goes back only six years and does not cover disclosures made prior to April 14, 2003. The first accounting is free but a fee will apply if more than one request is made in a 12-month period.
- Right to Request Special Restrictions: You may request that Healthy Advantage (HMO) Medicare provide special restrictions on the sharing of your PHI. If you are in a health care emergency, we may share restricted PHI without your permission.
- Right to Revoke Authorization: You have the right to revoke your authorization to disclose your PHI, except to the extent that action has already been taken in reliance on your authorization.
- Right to Request Paper Copy You have the right to request a paper copy of this notice even if you agree to receive it electronically.
Healthy Advantage (HMO) Medicare will follow the terms of the notice currently in effect. Healthy Advantage (HMO) Medicare reserves the right to change this notice and to make the new notice effective for all PHI that it maintains.
This Notice is Effective: January 1, 2006.
Contact Us
If you would like further information about your privacy rights, are concerned that your privacy rights have been violated, or disagree with a decision that we made about access to your PHI, contact:
Healthy Advantage (HMO) Medicare Customer Service
PO BOX 45180
Salt Lake City, UT 84145
1-877-644-0344