NEW BRAUNFELS UTILITIES
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy
Practices describes how protected health information may be used or disclosed by
your Group Health Plan to carry out payment, health care operations, and for
other purposes that are permitted or required by law. This Notice also sets out
our legal obligations concerning your protected health information, and
describes your rights to access and control your protected health information.
Protected health information (or "PHI") is individually
identifiable health information, including demographic information, collected
from you or created or received by a health care provider, a health plan, your
employer (when functioning on behalf of the group health plan), or a health care
clearinghouse and that relates to: (1) your past, present, or future physical
or mental health or condition; (2) the provision of health care to you; or (3)
the past, present, or future payment for the provision of health care to you.
This Notice of Privacy
Practices has been drafted to be consistent with what is known as the "HIPAA
Privacy Rule," and any of the terms not defined in this Notice should have the
same meaning as they have in the HIPAA Privacy Rule.
If you have any questions or
want additional information about the Notice or the policies and procedures
described in the Notice, please contact:
Human Resources Manager,
New
Braunfels Utilities, P.O. Box 310289, New Braunfels, TX, 78131-0289,
830-629-8495.
EFFECTIVE DATE
This Notice of Privacy Practices becomes effective on
April 14, 2004.
OUR RESPONSIBILITIES
We are required by law to
maintain the privacy of your PHI. We are obligated to provide you with a copy
of this Notice of our legal duties and of our privacy practices with respect to
PHI, and we must abide by the terms of this Notice. We reserve the right to
change the provisions of our Notice and make the new provisions effective for
all PHI that we maintain. If we make a material change to our Notice, we will
mail a revised Notice to the address that we have on record for you.
Primary Uses and Disclosures of Protected Health Information
The following is a
description of how we are most likely to use and/or disclose your PHI.
·
Payment
and Health Care Operations
We have the right to use and
disclose your PHI for all activities that are included within the definitions of
"payment" and "health care operations" as set out in 45 C.F.R. § 164.501 (this
provision is a part of the HIPAA Privacy Rule). We have not listed in this
Notice all of the activities included within these definitions, so please refer
to 45 C.F.R. § 164.501 for a complete list.
·
Payment
We will use or disclose your
PHI to pay claims for services provided to you and to obtain stop‑loss
reimbursements or to otherwise fulfill our responsibilities for coverage and
providing benefits. For example, we may disclose your PHI when a provider
requests information regarding your eligibility for coverage under our health
plan, or we may use your information to determine if a treatment that you
received was medically necessary.
·
Health
Care Operations
We will use or disclose your
PHI to support our business functions. These functions include, but are not
limited to: quality assessment and improvement, reviewing provider performance,
licensing, stop‑loss underwriting, business planning, and business development.
For example, we may use or disclose your PHI: (1) to provide you with
information about one of our disease management programs; (2) to respond to a
customer service inquiry from you; or (3) in connection with fraud and abuse
detection and compliance programs.
·
Business
Associates
We contract with individuals
and entities (Business Associates) to perform various functions on our behalf or
to provide certain types of services. To perform these functions or to provide
the services, our Business Associates will receive, create, maintain, use, or
disclose PHI, but only after we require the Business Associates to agree in
writing to contract terms designed to appropriately safeguard your information.
For example, we may disclose your PHI to a Business Associate to administer
claims or to provide service support, utilization management, subrogation, or
pharmacy benefit management. Examples of our business associates would be our
Third Party Administrator, which will be handling many of the functions in
connection with the operation of our Group Health Plan; the retail pharmacy; the
mail order pharmacy, the Employee Assistance Program, the Broker, the designated
Attorney, and the Financial Auditor.
·
Other
Covered Entities
We may use or disclose your
PHI to assist health care providers in connection with their treatment or
payment activities, or to assist other covered entities in connection with
payment activities and certain health care operations. For example, we may
disclose your PHI to a health care provider when needed by the provider to
render treatment to you. This also means that we may disclose or share your PHI
with other insurance carriers in order to coordinate benefits if you or your
family members have coverage through another carrier.
Potential Impact of State Law
The HIPAA Privacy
Regulations generally do 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 Regulations, 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 PHI concerning HIV or AIDS,
mental health, substance abuse/chemical dependency, genetic testing,
reproductive rights, etc.
Required Disclosures of Your
Protected Health Information
The following is a
description of disclosures that we are required by law to make.
·
Disclosures to the Secretary of the U.S. Department of Health and Human Services
We are required to disclose
your PHI to the Secretary of the U.S. Department of Health and Human Services
when the Secretary is investigating or determining our compliance with the HIPAA
Privacy Rule.
·
Disclosures to You
We are required to disclose
to you most of your PHI in a "designated record set" when you request access to
this information. Generally, a "designated record set" contains medical and
billing records, as well as other records that are used to make decisions about
your health care benefits. We also are required to provide, upon your request,
an accounting of most disclosures of your PHI that are for reasons other than
payment and health care operations and are not disclosed through a signed
authorization.
We will disclose your PHI to
an individual who has been designated by you as your personal representative and
who has qualified for such designation in accordance with relevant state law.
However, before we will disclose PHI to such a person, you must submit a written
notice of his/her designation, along with the documentation that supports
his/her qualification (such as a power of attorney).
Even if you designate a
personal representative,
the HIPAA Privacy
Rule permits us to elect not to treat the person as your personal representative
if we have a reasonable belief that: (1) you have been, or may be, subjected to
domestic violence, abuse, or neglect by such person; (2) treating such person as
your personal representative could endanger you; or (3) we determine, in the
exercise of our professional judgment, that it is not in your best interest to
treat the person as your personal representative.
Other Uses and Disclosures of Your Protected Health Information
Other uses and disclosures
of your PHI that are not described above will be made only with your written
authorization. If you provide us with such an authorization, you may revoke the
authorization in writing, and this revocation will be effective for future uses
and disclosures of PHI. However, the revocation will not be effective for
information that we already have used or disclosed, relying on the
authorization.
YOUR RIGHTS
The following is a
description of your rights with respect to your PHI.
·
Right to
Request a Restriction
You have the right to
request a restriction on the PHI we use or disclose about you for payment or
health care operations.
We are not required to agree
to any restriction that you may request.
If we do agree to the
restriction, we will comply with the restriction unless the information is
needed to provide emergency treatment to you.
You may request a
restriction by calling or writing us at New Braunfels Utilities, Human
Resources, P.O. Box 310289, New Braunfels, Texas 78131-0289, 830-629-8495. It
is important that you direct your request for restriction to this number/address
so that we can begin to process your request. Requests sent to persons or
offices other than the number/address indicated might delay processing the
request.
We will want to receive this
information in writing and will instruct you where to send your request when you
call. In your request, please tell us: (1) the information whose disclosure
you want to limit; and (2) how you want to limit our use and/or disclosure of
the information.
·
Right to
Request Confidential Communications
If you believe that a
disclosure of all or part of your PHI may endanger you, you may request that we
communicate with you regarding your information in an alternative manner or at
an alternative location. For example, you may ask that we only contact you at
your work address or via your work e‑mail.
You may request a
restriction by calling or writing us at New Braunfels Utilities, Human
Resources, P.O. Box 310289, New Braunfels, Texas 78131-0289, 830-629-8495. It
is important that you direct your request for confidential communications to
this number/address so that we can begin to process your request. Requests sent
to persons or offices other than the one indicated might delay processing the
request.
We will want to receive this
information in writing and will instruct you where to send your written request
when you call. In your request, please tell us: (1) that you want us to
communicate your PHI with you in an alternative manner or at an alternative
location; and (2) that the disclosure of all or part of the PHI in a manner
inconsistent with your instructions would put you in danger.
We will accommodate a
request for confidential communications that is reasonable and that states that
the disclosure of all or part of your PHI could endanger you. As permitted by
the HIPAA Privacy Rule, "reasonableness" will (and is permitted to) include,
when appropriate, making alternate arrangements regarding payment.
Accordingly, as a condition of granting your
request, you will be required to provide us information concerning how payment
will be handled. For example, if you submit a claim for payment, state or
federal law (or our own contractual obligations) may require that we disclose
certain financial claim information to the plan participant (e.g., an EOB).
Unless you have made other payment arrangements, the EOB (in which your PHI
might be included) will be released to the plan participant.
Once we receive all of the
information for such a request (along with the instructions for handling future
communications), the request will be processed usually within two business days.
Prior to receiving the
information necessary for this request, or during the time it takes to process
it, PHI may be disclosed (such as through an Explanation of Benefits or "EOB").
Therefore, it is extremely important that you contact us at the number listed in
the summary page of this Notice as soon as you determine that you
need to restrict disclosures of your PHI.
If you terminate your
request for confidential communications, the restriction will be removed for all
your PHI that we hold, including PHI that was previously protected. Therefore,
you should not terminate a request for confidential communications if you remain
concerned that disclosure of your PHI will endanger you.
·
Right to
Inspect and Copy
You have the right to inspect and copy your PHI that is contained in a
"designated record set." Generally, a "designated record set" contains medical
and billing records, as well as other records that are used to make decisions
about your health care benefits. However, you may not inspect or copy
psychotherapy notes or certain other information that may be contained in a
designated record set.
To inspect and copy your PHI
that is contained in a designated record set, you must submit your request by
calling us at the number listed in the summary page of this Notice. It is
important that you call this number to request an inspection and copying so that
we can begin to process your request. Requests sent to persons or offices other
than the one indicated might delay processing the request. If you request a
copy of the information, we may charge a fee for the costs of copying, mailing,
or supplies associated with your request.
We may deny your request to
inspect and copy your PHI in certain limited circumstances. If you are denied
access to your information, you may request that the denial be reviewed. To
request a review, you must contact us at the number provided in this Notice. A
licensed health care professional chosen by us will review your request and the
denial. The person performing this review will not be the same one who denied
your initial request. Under certain conditions, our denial will not be able to
be reviewed. If this event occurs, we will inform you in our denial that the
decision cannot be reviewed.
·
Right to
Amend
If you believe that your PHI is incorrect or incomplete, you may request that we
amend our information. You may request that we amend your information by
calling or writing us at New Braunfels Utilities, Human Resources, P.O. Box
310289, New Braunfels, Texas 78131-0289, 830-629-8495. Additionally, your
request should include the reason the amendment is necessary. It is important
that you direct your request for amendment to this number/address so that we can
begin to process your request. Requests sent to persons or offices other than
the one indicated might delay processing the request.
In certain cases, we may
deny your request for an amendment. For example, we may deny your request if
the information you want to amend is not maintained by us, but by another
entity. If we deny your request, you have the right to file a statement of
disagreement with us. Your statement of disagreement will be linked with the
disputed information and all future disclosures of the disputed information will
include your statement.
·
Right of
an Accounting
You have a right to an accounting of certain disclosures of your PHI that are
for reasons other than treatment, payment, or health care operations. No
accounting of disclosures is required for disclosures made pursuant to a signed
authorization by you or your personal representative. You should know that most
disclosures of PHI will be for purposes of payment or health care operations,
and, therefore, will not be subject to your right to an accounting. There also
are other exceptions to this right.
An accounting will include
the date(s) of the disclosure, to whom we made the disclosure, a brief
description of the information disclosed, and the purpose for the disclosure.
You may request an
accounting by submitting your request in writing to New Braunfels Utilities,
Human Resources, P.O. Box 310289, New Braunfels, Texas 78131-0289,
830-629-8495. It is important that you direct your request for an accounting to
this address so that we can begin to process your request. Requests sent to
persons or offices other than the one indicated might delay processing the
request.
Your request may be for
disclosures made up to six (6) years before the date of your request, but not
for disclosures made before April 14, 2004. The first list you request within a
12‑month period will be free. For additional lists, we may charge you for the
costs of providing the list. We will notify you of the cost involved and you
may choose to withdraw or modify your request at the time before any costs are
incurred.
·
Right to
a Paper Copy of This Notice
You are being provided a paper copy of this notice, and you may view it
electronically at New Braunfels Utilities' web site, nbutexas.com.
COMPLAINTS
You may complain to us if
you believe that we have violated your privacy rights. You may file a complaint
with us by calling us at the number listed in this Notice. A copy of a
complaint form is available from this contact office.
You also may file a
complaint with the Secretary of the U.S. Department of Health and Human
Services. Complaints filed directly with the Secretary must: (1) be in
writing; (2) contain the name of the entity against which the complaint is
lodged; (3) describe the relevant problems; and (4) be filed within 180 days of
the time you became or should have become aware of the problem. We will not
penalize or in any other way retaliate against you for filing a complaint with
the Secretary or with us.
For further information
about the complaint process, or to file a complaint, contact:
Curtis Jackson, Human
Resources Manager
P.O. Box 310289
Phone: 830-629-8495
Fax: 830-629-8435
For further information
about filing a complaint with the Secretary of Health and Human Servers, or to
file a complaint, contact:
U.S. Department of Health
and Human Services, Office for Civil Rights
Medical Privacy, Complaint Division
200 Independence Avenue, SW
HHH Building, Room 509H
Washington, D.C. 20201
Phone: 866-627-7748
TTY: 886-788-4989
This notice was published
and becomes effective on April 14, 2004.
