NNEBT

HIPAA and what it Means to you

Northern New England Benefit Trust
Notice of Privacy Practices

[Effective April 14, 2003]

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

This Notice of Privacy Practices describes how the Northern New England Benefit Trust (“Trust”) may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and to control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health condition and related health care services. The Trust is required by law to maintain the privacy of protected health information and to provide participants with notice of its legal duties and privacy practices with respect to protected health information. The Trust is required to abide by the terms of this Notice of Privacy Practices. The Trust, however, reserves the right to change the terms of this notice at any time and to make new provisions effective for all protected health information (not just for protected health information created or received after the effective date of the revised notice). The Trust will provide you, by mail, with any revised Notice of Privacy Practices upon your telephonic request.

Uses and Disclosures of Protected Health Information

A. For Treatment, Payment and Health Care Operations. The Trust may use and disclose your protected health information, without your authorization or consent, for treatment, payment and health care operations. Your protected health information may be used and disclosed by the Trust, our office staff and others outside of our office, who are involved in your care and treatment, for the purpose of providing managed care services to you. Your protected health information also may be used and disclosed to pay your health care bills and to support the Trust’s operation. The following are examples of the types of uses and disclosures of your protected health care information that the Trust is permitted to make. These examples are not meant to be exhaustive but, rather, merely describe the types of uses and disclosures that may be made by the Trust.

Treatment: The Trust may use and disclose your protected health information to provide, coordinate or manage your health care, including any related services. This includes the coordination or management of your health care with a third party. For example, the Trust may disclose your protected health information, as necessary, to consult with health care providers regarding your treatment and coordinate and manage your health care with others. Your protected health information also may be used or disclosed by the Trust in order to determine whether the Trust will authorize your care under the plan or whether your care will be covered by the plan. In addition, the Trust may use or disclose your protected health information from time-to-time to our physician consultants to review a plan of treatment or to consider an appeal.

Payment: The Trust may use your protected health information to pay and to obtain payment for your health care treatment and services; to fulfill the Trust’s coverage responsibilities; to provide benefits under the Plan; and to obtain or provide reimbursement and/or subrogation for the costs associated with your health care. This may include certain activities that the Plan may undertake before it approves or pays for the health care services provided by the Trust such as making a determination of eligibility or coverage for benefits, claims management, adjudicating claims and reviewing services provided to you for medical necessity, coverage, justification of charges and the like. For example, the Trust may use and disclose your protected health information to a health care provider in order to resolve issues related to the payment of your health care bills. The Trust also may use and disclose protected health information in order to obtain reimbursement for medical or disability payments made under the plan that resulted from injuries caused by a third-party. The Trust, in addition, may use and disclose protected health information to confirm that you are receiving the appropriate amount of care to obtain payment for services.

Health Care Operations: The Trust may use or disclose your protected health information in order to support the activities of the Trust. These activities include, but are not limited to, managing and administering the operation of the Trust and the terms of the plan; determining eligibility; reviewing and improving the quality and cost of care; managing and coordinating care; reviewing and evaluating providers; assisting the Trust in determining future benefits under the plan; quality assessment activities; employee review activities; reviewing services provided to you for medical necessity; reviewing the performance of health care providers; and conducting or arranging for other Trust related activities. For example, obtaining approval for a hospital stay may require that your relevant protected health information be used and disclosed by the Trust. The Trust also may use and disclose your protected health information to determine whether your care is medically necessary. The Trust additionally may send you information about the benefits and services provided by the Trust under the plan. The Trust may share your protected health information with third party “business associates” that perform various activities (e.g., billing, claims review, managed care reviews, legal, accounting, etc.) for the Trust. Whenever an arrangement between the Trust and a business associate involves the use or disclosure of your protected health information, the Trust will have a written contract with the business associate that contains terms that will protect the privacy of your protected health information.

B. Based Upon Your Written Authorization. Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization, at any time, in writing, except to the extent that the Trust has taken an action in reliance on the use or disclosure indicated in the authorization.

C. Made With Your Agreement, Authorization or Opportunity to Object. The Trust may use and disclose your protected health information, if you have the opportunity to agree or object to the use or disclosure of all or part of your protected health information; or if you are not present or able to agree or object to the use or disclosure of the protected health information, the Trust, using professional judgment, may determine whether the disclosure is in your best interest. In such a case, only the protected health information that is relevant to your health care will be disclosed.

Individuals Involved in Your Health Care: Unless you object, the Trust may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care. If you are present and able to consent or object, the Trust may only use or disclose protected health information, if you do not object after you have been informed of you opportunity to object. If you are not present or unable to agree or object to such a disclosure, the Trust may disclose such information as necessary if the Trust determines that it is in your best interest based on its professional judgment.

Emergencies: The Trust may use or disclose your protected health information in an emergency treatment situation.

D. Made Without Your Authorization or Opportunity to Object. The Trust may use or disclose your protected health information in the following situations without your authorization.

Required by Law: The Trust may use or disclose your protected health information to the extent that the use or disclosure is required by 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.

Public Health: The Trust may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability (including communicable diseases).

Health Oversight: The Trust may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.

Abuse or Neglect: The Trust may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, the Trust may disclose to the appropriate governmental entity your protected health information, if the Trust believes that you have been a victim of abuse, neglect or domestic violence. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

Legal Proceedings: The Trust may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized) and, under certain conditions, in response to a subpoena, discovery request or other lawful process.

Law Enforcement: The Trust also may disclose protected health information for law enforcement purposes, so long as applicable legal requirements are met. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of the Trust, and (6) certain medical emergencies not occurring at the Trust that involve criminal activity.

Threat to Health or Public Safety: Consistent with applicable federal and state laws, the Trust may disclose your protected health information, if the Trust believes that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. The Trust also may disclose protected health information, if it is necessary for law enforcement authorities to identify or apprehend an individual.

Workers’ Compensation: Your protected health information may be disclosed by the Trust to comply with workers’ compensation laws and other similar legally-established programs.

Incidental Disclosures: The Trust may use or disclose protected health information incident to a use or disclosure permitted by the HIPAA Privacy Rule so long as the Trust has reasonably safeguarded against such incidental uses and disclosures and has limited them to the minimum necessary information.

Military Activity and National Security: When the appropriate conditions apply, the Trust may use or disclose protected health information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits or (3) to foreign military authority if you are a member of that foreign military services. The Trust also may disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including the provision of protective services to the President or others legally authorized.

Disclosures Required By HIPAA: Under HIPAA, the Trust is required to disclose protected health information when required by the Secretary of the United States Department of Health and Human Services to investigate or determine our compliance with the requirements HIPAA Privacy Rule. The Trust also is required, in certain cases, to disclose protected health information upon your request to access protected health information or for an accounting of certain disclosures of protected health information about you as stated below.

A. Right to Inspect and Copy. You have the right to request the opportunity to inspect and obtain a copy of protected health information about you that is contained in certain records that are maintained by the Trust for as long as the Trust maintains the protected health information. This includes medical and billing records. You, however, may not inspect or copy the following records to the extent that they are in the possession of the Trust: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal or administrative action or proceeding and protected health information that is subject to other laws that prohibit access to protected health information. The Trust may deny a request to inspect and copy protected health information. In some circumstances, you may have a right to have this decision reviewed by the Trust. If you request a copy of protected health information about you, the Trust may charge you a reasonable fee for the copying, postage, labor and supplies used in meeting your request. Please contact our Privacy Officer if you have questions about access to your records.

B. Right to Request Restrictions. You may ask the Trust not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You also may request that any part of your protected health information not be disclosed to persons involved in your care as permitted by the Privacy Rule. However, the Trust is not required to agree to a restriction that you may request. If the Trust believes that it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. If the Trust does agree to the requested restriction, the Trust may not use or disclose your protected health information in violation of that restriction except in certain cases, including where it is needed to provide emergency treatment. You may request a restriction by forwarding a written request for restriction to the Privacy Officer, by United States mail, return receipt requested, postage prepaid, as to the restriction sought. Your request must state the specific information which you want to restrict, how you want to restrict the information and to whom you want the restrictions to apply. Within sixty (60) days following the Trust’s receipt of the written request, the Privacy Officer will notify you whether the Trust agrees or disagrees with the requested restriction.

C. Right to Receive Confidential Communications. You have the right to request that you receive confidential communications regarding your protected health information in a certain manner or at a certain location. The Trust, however, will accommodate only reasonable requests. The Trust will not request an explanation from you as to the basis for the request. All such requests must be made, in writing, to the Trust’s Privacy Officer by forwarding a written request, by United States mail, return receipt requested, postage prepaid.

D. Right to Amend. You have the right to request an amendment to your protected health information for as long as the Trust maintains this information. In certain cases, the Trust may deny your request for an amendment. If the Trust denies your request for amendment, you have the right to file a statement of disagreement with the Trust and the Trust may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. All such requests for amendment must be made in writing to the Trust’s Privacy Officer by United States mail, return receipt requested, postage prepaid.

E. Right to Receive an Accounting of Disclosures. You have the right to request an “accounting” of certain disclosures that the Trust has made of protected health information about you. This right applies to disclosures for purposes other than treatment, payment or healthcare operations; to family members or friends involved in your care; to you directly; pursuant to an authorization by you or your personal representative; certain notification purposes; as incidental disclosures that occur as a result of otherwise permitted disclosures; and as part of a limited data set that doesn’t directly identify you. You have the right to receive specific information regarding these disclosures that occur after April 14, 2003. You may request a shorter time-frame. The right to receive this information is subject to certain exceptions, restrictions and limitations. All such requests for accounting must be to the Trust’s Privacy Officer by forwarding a written request by United States mail, return receipt requested, postage prepaid.

F. Right to Obtain a Paper Copy of this Notice. You have the right to receive a paper copy of this notice at any time even if you have agreed to accept this notice electronically. All such requests for a paper copy must be made to the Trust’s Privacy Officer.

G. Complaint Procedure. You may complain to us or to the Secretary of the United States Department of Health and Human Services if you believe your privacy rights have been violated by the Trust. To file a complaint with the Trust, please notify the Privacy Officer at the address and number listed below. Complaints also may be filed with the U. S. Department of Health and Human Services, Office for Civil Rights, Medical Privacy, Complaint Division, 200 Independence Avenue, SW, Washington, D.C. 20201; Toll free Phone: 877-696-6775; Phone: 866-627-7748; e-mail: www.hhs.gov/ocr. The Trust will not retaliate against you for filing a complaint.

Questions

If you have any questions about this notice, please contact the Trust’s Privacy Officer at the following address and following telephone number: Marcia MacGregor, Privacy Officer, Northern New England Benefit Trust, 51 Goffstown Road, P.O. Box 4604, Manchester, New Hampshire 03108; Telephone Number: (800) 258-9732.

This notice was published and first became effective April 14, 2003.

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HIPAA Notice

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