Notice of Privacy Practices

Employee Benefit Consultants, Inc. (EBC) is committed to maintaining the confidentiality of your medical information. This Notice of Privacy Practices (“Notice”) describes EBC’s efforts to safeguard your health information from improper or unnecessary use or disclosure. This Notice only applies to health-related information created or received by or on behalf of EBC Clients’ group health plans (the “Health Plans”, which are administered by EBC. This Notice applies to employees, certain former employees, and dependents who participate in the Health Plans.

What is Protected?

The Health Plans require EBC to keep “Protected Health Information”, or “PHI” about you private. PHI is health information that can be used to identify you and that relates to:

• your physical or mental health condition
• the provision of health care to you
• payment for your health care

Your medical and dental records, your claims for medical and dental benefits, and the explanatio of benefits sent in connection with payment of your claims are all examples of PHI.

If EBC obtains your health information in another way (for example, health information obtained by a non-health-related benefits plan, such as a Disability claim), that information is not considered to be PHI and is not protected under this Notice; however, EBC will safeguard that information in accordance with applicable laws.

Uses and Disclosures of PHI

To protect the privacy of your PHI, EBC guards the physical security of PHI and limits the way PHI is disclosed to others. EBC may use or disclose PHI in certain permissible ways described below. To the extent required under federal health information privacy law, only the minimum amount of PHI necessary to perform a task will be used or disclosed.

• To determine proper payment of your Health Plan benefit claim - EBC uses and discloses PHI to reimburse you or your doctors or health care providers for covered treatments and services. For example, your diagnosis information may be used to determine whether a specific procedure is medically necessary or to reimburse your doctor for your medical care.
• For the administration and operation of EBC - PHI may be used for numerous administrative and quality control functions necessary for EBC’s proper operation. For example, claims information may be used for fraud and abuse detection activities or to conduct data analyses for cost-control.
• To inform you or your health care provider about treatment alternatives or other health-related benefits that may be offered under a Health Plan - For example, your claims data may be used to alert you to an available case management program.
• To a health care provider if needed for your treatment – For example, your prescription information may be disclosed to a pharmacist regarding a drug interaction concern.
• To a health care provider or to a non-EBC health plan to determine proper payment of your claim under the other plan - For example, your PHI may be exchanged with your spouse’s health plan for coordination of benefits purposes.
• To a family member, friend, or other person involved in your health care if you are present and do not object to the sharing of PHI, or in the event of an emergency.
• To comply with applicable federal, state, or local law.
• For public health reasons, including (1) to a public health authority for the prevention or control of disease, injury or disability; (2) to a proper government or health authority to report child abuse or neglect; (3) to report reactions to medications or problems with products regulated by the Food and Drug Administration; (4) to notify individuals of recalls of medication or products they may be using; or (5) to notify a person who may have been exposed to a communicable disease or who may be at risk for contracting or spreading a disease or condition.
• To report a suspected case of abuse, neglect, or domestic violence, as permitted or required by applicable law.
• To comply with health oversight activities, such as audits, investigations, inspections, licensure actions, and other government monitoring and activities related to health care provision or public benefits or services.
• For the U.S. Department of Health and Human Services to demonstrate our compliance with federal health information privacy law.
• To respond to an order of a court or administrative tribunal, such as a court ordered warrant, subpoena or summons, grand jury subpoena, or administrative subpoena or other request.
• To respond to a subpoena, warrant, summons or other legal request if sufficient safeguards, such as a protective order in the case of a private lawsuit, are in place to maintain PHI privacy.
• To a law enforcement official for a law enforcement purpose as required by law.
• For purposes of public safety or national security.
• To allow a coroner or medical examiner to identify you or determine your cause of death.
• To allow a funeral director to carry out his or her duties.
• To respond to a request by military command authorities if you are or were a member of the armed forces.

Other Uses and Disclosures of PHI

You must give your written authorization before your PHI is used or disclosed for any purpose beyond those listed above. You may revoke your authorization, in writing, at any time. If you revoke your authorization, EBC will no longer use or disclose PHI except as described above (or as permitted by any other authorizations that have not been revoked.) However, please understand that EBC cannot retrieve any PHI disclosed to a third party in reliance on your prior authorization.

Your Rights

Federal law provides you with certain rights regarding PHI that pertains to you. Parents of minor children and other individuals with legal authority to make health decisions for a Health Plan participant may exercise these rights on behalf of the participant.

• Right to request restrictions
  
  You have the right to request a restriction or limitation on the use or disclosure of PHI. Because we use PHI only as necessary to pay Health Plan benefits, to administer the Health Plan, and to comply with the law, it may not be possible to agree to your request. The law does not require the Health Plans or EBC to agree to your request for restriction. You may make a request for restriction on the use and disclosure of PHI by contacting the Health Plan or EBC.
  
  
• Right to receive confidential communications
  
  You have the right to request that EBC communicate with you about PHI at an alternative address or by alternative means if you believe that communication through normal business practices could endanger you. For example, you may request that the Health Plan or EBC contact you only at work and not at home.
  
  
We will accommodate all reasonable requests if you clearly state that you are requesting the confidential communication because you feel that disclosure in another way could endanger your safety.


• Right to inspect and obtain a copy of PHI
  
  You have the right to inspect and obtain a copy of PHI that is contained in records that the Health Plan or EBC maintain for enrollment, payment, claims determination, or case or medical management activities, or that we use to make enrollment coverage, or payment decisions about you.
  
  
However, we will not give you access to PHI records that have been created in anticipation of a civil, criminal, or administrative action or proceeding. We will also deny your request to inspect and obtain a copy of PHI if it has been determined that giving you the requested access is reasonably likely to endanger the life or physical safety of you or another individual or to cause substantial harm to you or another individual. Likewise, your request will be denied if the record makes references to another person (other than a health care provider), and the requested access would likely cause substantial harm to the other person.

You may be charged a fee to cover costs of copying, mailing or other supplies directly related to your request. You will be notified of any costs before you incur any expenses.


• Right to amend PHI
  
  You have the right to request an amendment of PHI if you believe the information EBC has about you is incorrect or incomplete. You have this right as long as PHI is maintained by EBC. EBC will correct any mistakes if it created the PHI. However, EBC cannot amend PHI that it believes to be accurate and complete.
  
  
• Right to receive an accounting of disclosures of PHI
  
  You have the right to request a list of certain disclosures of PHI by EBC. The accounting will not include any of the disclosures allowed by law as listed in the “Uses and Disclosures of PHI” portion of this Notice. We may charge you for costs associated with providing you these accountings. We will notify you in advance of any costs, and you may choose to withdraw or modify your request before you incur any expenses.
  
  
• Right to file a complaint
  
  If you believe your rights have been violated, you should let us know immediately. We will take steps to remedy any violations of the Health Plan’s privacy policy or of this Notice.
  
  
You may file a formal complaint with the Health Plan or with the United States Department of Health and Human Services as described in your Plan’s privacy policy.

Personal Representatives

You may exercise your rights through a personal representative. Your personal representative must produce evidence of his or her authority to act on your behalf before that person will be given access to your PHI. Proof of such authority may include: (a) a notarized power of attorney; (b) a court order appointing the person as the guardian of the individual; or (c) an individual who is the parent of a minor child. The Health Plan and EBC retain discretion to deny access to your PHI to a personal representative to provide protection to those who may be subject to abuse or neglect. This also applies to personal representatives of minors.

---