Member Privacy Notice
IMPORTANT NOTICE TO ALL INSUREDS
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USEDAND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Your Privacy is Important to Us
Carolina Care Plan has always been committed to protecting the information you share with us and is required by law to maintain the privacy of your protected health information. Carolina Care Plan holds its employees and consultants to strict policies and procedures protecting your information. Carolina Care Plan is required by law to provide you this Notice of its duties and privacy practices. All employees must sign confidentiality agreements. In addition, Carolina Care Plan employs various technologies to prevent unauthorized access to data. This Privacy Statement will explain the type of information we collect, how we use that information, how we protect that information, your rights as they relate to your information and our legal duties and privacy practices.
What Information We Collect
Carolina Care Plan understands your concerns regarding the confidentiality of information you share with us. We collect information from you on applications and other transactions with us. This information can include name, address and social security number. Under certain conditions we may also ask you and your covered dependents for medical history information. We also have access to your information through claims submitted to our company from healthcare providers, information provided by your employer if your coverage is through a group contract and from your agent.
How We Use and Disclose Your Information
We are permitted by law to use your information for certain purposes including healthcare payment and healthcare operations. Examples of how we may use and disclose your information include but are not limited to:
Payment: Carolina Care Plan may use or disclose your information to pay claims for covered services or to provide eligibility information to your doctor when you receive treatment.
Healthcare Operations: Carolina Care Plan may use or disclose your information for activities like (1) underwriting, premium rating or other activities relating to the creation or renewal of a health insurance contract; (2) quality assessment and improvement activities such as peer review and credentialing of providers; (3) care and disease management activities; and (4) data and information systems management.
As required by law: Carolina Care Plan must allow the U.S. Department of Health and Human Services access to audit its records. In addition, Carolina Care Plan may be required to release your information to comply with other laws including:
• To comply with legal proceedings, such as court orders or administrative order or subpoenas.
• To perform mandatory licensing, regulatory/compliance reporting.
• To law enforcement officials for limited law enforcement purposes.
• To federal officials for lawful intelligence, counterintelligence and other national security purposes.
• To Public Health Authorities for public health purposes.
• To comply with workers’ compensation and other similar programs established by law that provide benefits for work-related injuries or illness without regard to fault.
To Business Associates: Carolina Care Plan may disclose your information to third parties that it hires to assist in the administration of your benefits. These third parties are called Business Associates and they must agree in writing to protect and maintain the confidentiality and security of your information. Examples of a Business Associate are the doctors who perform medical reviews and our brokers who service your policy.
To Plan Sponsors: If you receive insurance benefits through a group plan, Carolina Care Plan may disclose to your Plan Sponsor, in summary form, claims history and other similar information. Such summary information does not disclose your name or other distinguishing characteristics. Carolina Care Plan may also disclose to your Plan Sponsor the fact that you are enrolled in, or disenrolled from the Plan. Carolina Care Plan may disclose your medical information to the Plan Sponsor for Plan administrative functions that the Plan Sponsor provides to the Plan if the Plan Sponsor agrees in writing to ensure the continuing confidentiality and security of your medical information. The Plan Sponsor must also agree not to use or disclose your medical information for employment-related activities or for any other benefit or benefit plans of the Plan Sponsor.
Other Uses and Disclosures: Other disclosures that Carolina Care Plan may make:
• To your personal representative appointed by you or designated by law.
• To appropriate military authorities, if you are a member of the armed forces
• To a family member, friend or other person, for the purpose of helping you with your healthcare or healthcare payment if you are in an emergency situation and you cannot give your agreement to Carolina Care Plan to do this.
• To inform you of other health related benefits or services that may be of interest to you.
Uses and Disclosures with your permission: Carolina Care Plan will not use or disclose your information for any purpose not outlined in this notice unless you give Carolina Care Plan your written authorization to do so. We do not make disclosures of information to any other companies that may want to sell their products or services to you. If you give Carolina Care Plan your written authorization, you may revoke that authorization at any time unless Carolina Care Plan has taken action in reliance of your authorization. To receive an authorization form, please contact Customer Service at the telephone number on the back of your identification card or print one from our web site, www.CarolinaCarePlan.com under the Member Services Section. If a family member calls with knowledge of your claim, we may confirm certain information about it, unless you have informed us in writing of a need for confidential communication.
Your Rights
Below are your privacy and confidentiality rights as a member of Carolina Care Plan. Please note that all requests must be made in writing. We have provided forms to help in processing your request. The appropriate forms are available under the Member Services Section at our web site, www.CarolinaCarePlan.com. You also may call Customer Service at the telephone number on the back of your identification card to obtain a copy of the applicable form. All completed forms and requests are to be mailed to:
Carolina Care Plan
P.O. Box 100234
Columbia, SC 29202-3234
Requests with incomplete information will not be processed and you will not be notified.
Restriction: You may request that Carolina Care Plan place additional restrictions on the use and disclosure of your information to carry out treatment, payment or healthcare operations. Carolina Care Plan does not have to agree to your request. Please use the form provided under the Member Services Section at our web site www.CarolinaCarePlan.com to submit your request. Be sure to provide all required information including your name, your birthday, the policy number under which you are covered, and a clear explanation of your request. Carolina Care Plan will send a written confirmation regarding the disposition of your request.
Confidential Communication: You may request that Carolina Care Plan communicate with you in confidence about your information at a different location. Carolina Care Plan does not have to honor this request unless (1) such a change in communication is necessary to avoid endangering you; (2) your request allows Carolina Care Plan to continue collecting premiums and pay claims; and (3) your request is reasonable. Please use the form provided under the Member Services Section at our web site www.CarolinaCarePlan .com to submit your request. Be sure to provide all required information including your name, your social security number, your group number, your birthday, the policy number under which you are covered, the full address of where you would like future communication to be sent and the reason for the request.
The request will take ten (10) business days to process from the date received. You will receive a letter confirming the activation of the alternate address. All communications regarding your information will be sent to the alternate address once this request has been made or until you notify us otherwise. Use of an alternate address cannot be applied to communications sent prior to processing your request.
Access to your information: You have a right to access your information used and stored by Carolina Care Plan in its designated record set. For access to your entire medical record, you will have to contact the provider of service. Please use the form provided under the Member Services Section at our web site www.CarolinaCarePlan.com to submit your requests for access to your records. Be sure to provide all required information including your name, your birthday, the policy number under which you are covered, the group number under which you are covered, your social security number, the information you would like to access and the dates of information you would like to see.
Amend your information: You have the right to request an amendment of your information. Carolina Care Plan cannot amend information it did not create and will refer you to the provider of service if you are requesting an amendment to diagnosis or treatment information. Please use the form provided under the Member Services Section at our web site www.CarolinaCarePlan.com to submit your requests to amend your records. Be sure to provide all required information including your name, your birthday, the policy number under which you are covered, the information you are requesting be amended, and an explanation as to why you believe the information is incorrect
or incomplete. You have a right to an appeal if your request for an amendment is denied. These rights will be explained to you if your request is denied.
Disclosures: You have a right to an accounting of certain disclosures of your information made by Carolina Care Plan and its Business Associates over the last six (6) years (but not for disclosures made before April 14, 2003). Please use the form provided under the Member Services Section at our web site www.CarolinaCarePlan.com to submit your requests for an accounting of disclosures of your records. Be sure to provide all required information including your name, your birthday, the policy number under which you are covered, and a statement explaining your specific request.
Complaints: You have the right to complain if you believe your rights have been violated. You may use the form provided under the Member Services Section at our web site www.CarolinaCarePlan.com to submit your complaints. Be sure to provide all required information including your name, your birthday, the policy number under which you are covered, and an explanation regarding your complaint in as much detail as possible. You may file a complaint by contacting Customer Service at the telephone number on the back of your identification card, if you wish not to send it in writing.
You also have the right to complain to the Secretary of the U.S. Department of Health and Human Services, Hubert Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. Federal law prohibits retaliation against you if you chose to file a complaint.
Contact Information: If you have questions or would like an additional copy of this notice, please contact Customer Service at the telephone number on the back of your identification card.
Effective Date
The effective date of this notice is September 1, 2007. Carolina Care Plan is required to follow the terms of this notice until it is replaced. Carolina Care Plan reserves the right to change this Privacy Statement at any time as allowed by law and will notify you of any changes as required by law. Carolina Care Plan reserves the right to make the changes apply to all information that it maintains.