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Notice of Privacy Practices: |
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MAINTAINING
PRIVACY
Northern Insurance takes the privacy and
security of your data very seriously. We
want to inform you of the steps we take to
ensure the privacy of your data - and also
let you know what you can do to help |
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THIS NOTICE DESCRIBES
HOW PROTECTED HEALTH INFORMATION ABOUT
YOU MAY BE USED AND DISCLOSED AND HOW YOU
CAN GET ACCESS TO THIS INFORMATION. PLEASE
REVIEW IT CAREFULLY.
This Notice tells you about the ways in which Northern Insurance Services * (referred
to as "Northern") may collect, use and disclose your protected health
information and your rights concerning your protected health information. "Protected
health information"
is information about you, including demographic
information, that can reasonably be used
to identify you and that relates to your
past, present or future physical or mental
health or condition, the provision of
health care to you or the payment for
that care. We are required by federal
and state law to provide you with this
Notice about your rights and our legal
duties and privacy practices with respect
to your protected health information.
We must follow the terms of this Notice
while it is in effect. Some of the uses
and disclosures described in this Notice
may be limited in certain cases by applicable
state laws that are more stringent than
the federal standards. These provisions
will remain effective even if your coverage
is terminated, to the extent we retain
information about you.
HOW WE MAY USE AND DISCLOSE
YOUR
PROTECTED HEALTH INFORMATION
We may use and disclose your protected health information for different purposes.
The types of data containing protected health information (PHI) that Northern,
normally maintains are enrollment, claims adjudication, premium payments, case
or medical management data, or any other group of records maintained by Northern,
and are used in whole or in part to make decisions about a member's eligibility
and/or benefits. The examples below are provided to illustrate the types of uses
and disclosures we may make without your authorization for payment, health care
operations and treatment.
- Payment. We use
and disclose your protected health
information in order to pay for your
covered health expenses. For example,
we may use your protected health
information to process claims or
be reimbursed by another insurer
that may be responsible for payment.
Health Care Operations. We
use and disclose your protected
health information in order
to perform our plan activities,
such as quality assessment
activities or administrative
activities, including data
management or customer service.
In some cases, we may use
or disclose the information
for underwriting or determining
premiums.
- Treatment. We
may use and disclose your protected
health information to assist your
health care providers (doctors, dentists,
pharmacies, hospitals and others)
in your diagnosis and treatment.
For example, we may disclose your
protected health information to providers
to provide information about alternative
treatments.
- Plan Sponsor. If
you are enrolled through a group
health plan, we may provide summaries
of claims and expenses for enrollees
in a group health plan to the plan
sponsor, which is usually the employer.
- Enrolled Dependents and
Family Members. We will
mail explanation of benefits forms
and other mailings containing protected
health information to the address
we have on record for the subscriber
of the health plan.
OTHER PERMITTED OR REQUIRED
DISCLOSURES
- As Required by Law. We
must disclose protected health information
about you when required to do so
by law.
- Public Health Activities. We
may disclose protected health information
to public health agencies for reasons
such as preventing or controlling
disease, injury or disability.
- Victims of Abuse, Neglect
or Domestic Violence. We
may disclose protected health information
to government agencies about abuse,
neglect or domestic violence.
- Health Oversight Activities. We
may disclose protected health information
to government oversight agencies
(e.g., state insurance departments)
for activities authorized by law.
- Judicial and Administrative
Proceedings. We may disclose
protected health information in
response to a court or administrative
order. We may also disclose protected
health information about you in
certain cases in response to a
subpoena, discovery request or
other lawful process.
- Law Enforcement. We
may disclose protected health information
under limited circumstances to a
law enforcement official in response
to a warrant or similar process;
to identify or locate a suspect;
or to provide information about the
victim of a crime.
- Coroners, Funeral Directors,
Organ Donation. We may
release protected health information
to coroners or funeral directors
as necessary to allow them to carry
out their duties. We may also disclose
protected health information in
connection with organ or tissue
donation.
- Research. Under
certain circumstances, we may disclose
protected health information about
you for research purposes, provided
certain measures have been taken
to protect your privacy.
- To Avert a Serious Threat
to Health or Safety. We
may disclose protected health information
about you, with some limitations,
when necessary to prevent a serious
threat to your health and safety
or the health and safety of the
public or another person.
Special Government Functions. We
may disclose information as required
by military authorities or to authorized
federal officials for national security
and intelligence activities.
- Workers' Compensation. We
may disclose protected health information
to the extent necessary to comply
with state law for workers' compensation
programs.
OTHER USES OR DISCLOSURES WITH
AN AUTHORIZATION
Other uses or disclosures of your protected health information will be made only
with your written authorization, unless otherwise permitted or required by law.
You may revoke an authorization at any time in writing, except to the extent
that we have already taken action on the information disclosed or if we are permitted
by law to use the information to contest a claim or coverage under Northern.
YOUR RIGHTS REGARDING YOUR PROTECTED
HEALTH INFORMATION
You have certain rights regarding protected health information that Northern
maintains about you.
- Right To Access Your Protected
Health Information. You
have the right to review or obtain
copies of your protected health
information records, with some
limited exceptions. Usually the
records include enrollment, billing,
claims payment and case or medical
management records. Your request
to review and/or obtain a copy
of your protected health information
records must be made in writing.
We may charge a fee for the costs
of producing, copying and mailing
your requested information, but
we will tell you the cost in advance.
- Right To Amend Your Protected
Health Information. If
you feel that protected health
information maintained by Northern
is incorrect or incomplete, you
may request that we amend the information.
Your request must be made in writing
and must include the reason you
are seeking a change. We may deny
your request if, for example, you
ask us to amend information that
was not created by Northern, as
is often the case for health information
in our records, or you ask to amend
a record that is already accurate
and complete. If we deny your request
to amend, we will notify you in
writing. You then have the right
to submit to us a written statement
of disagreement with our decision
and we have the right to rebut
that statement.
- Right to an Accounting
of Disclosures by the Plan. You
have the right to request an accounting
of disclosures we have made of
your protected health information.
The list will not include our disclosures
related to your treatment, our
payment or health care operations,
or disclosures made to you or with
your authorization. The list may
also exclude certain other disclosures,
such as for national security purposes.
- Your request for an accounting
of disclosures must be made in writing
and must state a time period for
which you want an accounting. This
time period 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 electronically). The first accounting
that you request within a 12-month
period will be free. For additional
lists within the same time period,
we may charge for providing the accounting,
but we will tell you the cost in
advance.
- Right To Request Restrictions
on the Use and Disclosure of Your
Protected Health Information. You
have the right to request that
we restrict or limit how we use
or disclose your protected health
information for treatment, payment
or health care operations. We
may not agree to your request. If
we do agree, we will comply with
your request unless the information
is needed for an emergency. Your
request for a restriction must
be made in writing. In your request,
you must tell us (1) what information
you want to limit; (2) whether
you want to limit how we use or
disclose your information, or both;
and (3) to whom you want the restrictions
to apply.
- Right To Receive Confidential
Communications. You have
the right to request that we use
a certain method to communicate
with you about Northern or that
we send Plan information to a certain
location if the communication could
endanger you. Your request to receive
confidential communications must
be made in writing. Your request
must clearly state that all or
part of the communication from
us could endanger you. 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
a right at any time to request
a paper copy of this Notice, even
if you had previously agreed to
receive an electronic copy.
- Contact Information for
Exercising Your Rights. You
may exercise any of the rights
described above by contacting our
privacy office. See the end of
this Notice for the contact information.
HEALTH INFORMATION SECURITY
Northern requires its employees to follow the Northern security policies and
procedures that limit access to health information about members to those employees
who need it to perform their job responsibilities. In addition, Northern maintains
physical, administrative and technical security measures to safeguard your protected
health information.
CHANGES TO THIS NOTICE
We reserve the right to change the terms of this Notice at any time, effective
for protected health information that we already have about you as well as any
information that we receive in the future. We will provide you with a copy of
the new Notice whenever we make a material change to the privacy practices described
in this Notice. We also post a copy of our current Notice on our website at
http://www.Norinsco.com
. Any time we make a material change to this Notice, we will promptly
revise and issue the new Notice with the new effective date.
COMPLAINTS
If you believe that your privacy rights have been violated, you may file a complaint
with us and/or with the Secretary of the Department of Health and Human Services.
Please refer to your Evidence of Coverage for information as to how complaints
may be filed or your complaint may be sent to the privacy office listed at the
end of this Notice. We support your right to protect the privacy of your protected
health information. We will not retaliate against you or penalize you for filing
a complaint.
CONTACT THE PLAN
If you have any complaints or questions about this Notice or you want to submit
a written request to Northern as required in any of the previous sections of
this Notice, please contact the customer services department listed below. You
may also contact the IT Department, at:
IT Department
Northern Insurance Services, Inc.
771 E. Daily Dr., Suite
130, Camarillo, CA 93010
Phone: 800.227.6474 Fax: 800-842-5591
Email: theadmin@norinsurance.com
This Notice of Privacy Practices also applies to enrollees in any of the following
Northern Insurance Services entities:
Northern Insurance Services, Inc.
dba Northern Health Insurance
Services
www.Norinsco.com
www.northernhealthinsurance.com |
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