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 

EFFECTIVE DATE
This notice is effective August 20, 2012.

YOUR PRIVACY IS IMPORTANT TO US
The Ohio AFSCME Care Plan has always been committed to protecting the information that you share with us and is required by law to maintain the privacy of your protected health information (“PHI”). The Ohio AFSCME Care Plan holds its employees and consultants to strict policies and procedures regarding the security of your information. This Notice Of Privacy Practices will explain the type of information that 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.

USE AND DISCLOSURE OF HEALTH INFORMATION
The benefit plans of the Ohio AFSCME Care Plan ( the “Plan”) and its Business Associates may use your health information, that is, information that constitutes protected health information as defined in the Privacy Rule of the Administrative Simplification provision of the Health Insurance portability and Accountability Act of 1996 ( “HIPAA”), without authorization, consent or opportunity to agree or object for purposes of making or obtaining payment for your care and conducting health care operations. The Plan has amended its plan documents to protect your PHI as required by HIPAA. The Plan has established policies and procedures as well as administrative, technical and physical safeguards to prevent unnecessary disclosure of your health information.

THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED. 

To make or Obtain Payment. The Plan may use or disclose your health information to make payment to or collect payment from third parties, such as other health plans or health care providers, for the care you receive. For example, the Plan may provide information regarding your coverage or health care treatment to a care provider to confirm your coverage at the time of treatment or to other health plans to coordinate payment of benefits.

To Conduct Health Care Operations. The Plan may use or disclose health information for its own operations to facilitate the administration of the Plan and as necessary to provide coverage and service to all of the Plan’s participants. Health care operations includes such activities as:

• Quality assessment and improvement activities.
• Activities designed to improve overall health or reduce health care costs, including disease management.
• Contacting health care providers and participants with information about treatment alternatives and other related functions.
• Review or evaluation of the competency or qualifications of health care professionals, including performance evaluation.
• Accreditation, certification, licensing or credentialing activities.
• Establishement of contribution rates, stop loss rates and benefit plans.
• Clinical guideline and protocol development, case management and care coordination.
• Conducting or arranging for review or auditing functions, including compliance reviews, medical reviews, legal services, audit services, fraud and abuse detection programs, and compliance programs.
• Cost containment planning and analysis.
• Management of general administrative activities of the Plan, including member service and resolution of grievances.

For example, the Plan may use your health information to conduct case management, quality improvement and utilization review, and provider credentialing activities or to engage in member service and grievance resolution activities. In addition, the Plan may use your health information to refer you to disease management or wellness programs, project future costs related to benefits or audit the accuracy of claims processing functions.

For Treatment Alternatives/ Appointment Reminders. The Plan may use and disclose your health information to provide information to you about or to recommend possible treatment options or alternatives that may be of interest to you, or to provide appointment reminders.

For Distribution of Health-Related Benefits and Services. The Plan may use or disclose your health information to provide to you information regarding health-related benefits and services that may be of interest to you.

To Business Associates. The plan may disclose your health information to third parties that it hires to provide administrative services with respect to your benefits under the Plan. These third parties are referred to as Business Associates and they must agree to protect the privacy, security and confidentiality of your health information. Examples of Business Associates are the attorneys who perform legal services on behalf of the Plan and the consultants who provide utilization reviews and cost analysis with respect to specific benefits provided by the Plan.

For Disclosure to the Plan Sponsor.  Ohio AFSCME Care Plan Sponsor for the Plan. The Plan may disclose your health information to the Plan Sponsor for plan administrative functions performed by the Plan Sponsor on behalf of the Plan. In addition, the Plan may provide summary health information to the Plan Sponsor so that the Plan Sponsor may solicit premium bids from the health insurers or modify, amend or terminate the plan. The Plan also may disclose information to the Plan Sponsor regarding whether you or eligible dependents are participating in the health plan.

To Contributing Employers: The Plan may disclose to your Contributing Employer whether you are enrolled in, or disenrolled in, the Plan.

Other Disclosures: Other disclosures that the Plan may make:

• To your personal representative appointed by you or as designated by law.
• To a family member, friend or other person, for the purpose of helping you with our health care or health care payment if you are in an emergency situation and you cannot give your agreement to the Plan to do so.

When Legally Required. The Plan will disclose your health information when it is required to do so by any federal, state, or local law. For example, we may disclose your health information when required by a court order in a litigation proceeding such as a malpractice action.

To Conduct Health Oversight Activities. The Plan may disclose your health information to a health oversight agency for authorized activities including audits, inspections, licensure, civil administration, or disciplinary action. The Plan, however, may not disclose your health information if you are the subject of an investigation and the investigation does not arise out of or is not directly related  to your receipt of health care or public benefits.

In Connection With Judicial and Administrative Proceedings.  As permitted or required by state law, the Plan may disclose your health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a subpoena, discovery request or other lawful process, but only when the Plan makes reasonable efforts to either notify you about the request or to obtain an order protecting your health information.

For Law Enforcement Purposes. As permitted or required by state law, the Plan may disclose your health information to a law enforcement official for certain law enforcement purposes, including, but not limited to, if the Plan has a suspicion that your death was the result of criminal conduct or in an emergency to report potential criminal activity.

In the Event of a Serious Threat to Health or Safety. The Plan may, consistent with applicable law and ethical standards of conduct, disclose your health information if the Plan, in good faith, believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety to the general public. For example, we may disclose your medical information in a proceeding concerning the licensure of a physician.

For Specified Government Functions. In certain circumstances, federal regulations require the Plan to use or disclose your health information to facilitate specified government functions related to the military and veterans, national security and intelligence activities, protective services for the president and others, and correctional institutions and inmates.

For Workers’ Compensation. The Plan may release your health information to the extent necessary to the comply with laws related to workers’ compensation or similar programs. These programs provide benefits for injuries or illnesses that are work-related.

AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION
Other than as stated above, the Plan will not disclose your health information other than with your written authorization. If you authorize the Plan to use or disclose your health information, you may revoke that authorization in writing at any time.

YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
You have the following rights regarding your health information that the Plan maintains:

Right to Request Restrictions. You have the right to request restrictions on certain uses and disclosures of health information. You have the right to request a limit on the Plan’s disclosure of health information to someone involved in the payment of your care. However, the Plan is not required to agree to your request for restrictions, please contact the Privacy Official, c/o Michael D. Bauer (1603 East 27th Street, Cleveland, OH, 44114; Phone: 216-781-6420).

Right To Receive Confidential Communications. You have the right to request that the Plan communicate with you in a particular way if you believe that the disclosure of your health information could endanger you. For example, you may ask that the Plan only communicate with you at a certain telephone number or by email. If you wish to receive confidential communications, please make your request in writing to the Privacy Official, c/o Michael D. Bauer (1603 east 27th Street, Cleveland, OH, 44114; Phone: 216-781-6420; fax: 216 781-0398). The request will take a period of time to process from the date that it is received. All communications regarding your health information will be sent to alternate address once this request has been received, processed and approved or until you notify the Plan otherwise. Use of an alternate address cannot be applied to communications sent prior to the processing of your request. The Plan will attempt to honor your reasonable requests for confidential communications.

Right to Inspect and Copy your Health Information. You have the right to inspect and copy your health information. A request to inspect and copy records containing your health information must be made in writing to the Privacy Official, c/o Michael D. Bauer (1603 east 27th  Street, Cleveland, OH, 44114; Phone: 216-781-6420; Fax: 216-781-0398). If you request a copy of your health information, the Plan may charge a reasonable fee for copying, mailing, or other costs associated with your request, as applicable.

Right to Amend Your Health Information. If you believe that your health information records are inaccurate or incomplete, you may request that the Plan amend the records. Such a request may be made as long as the information is maintained by the Plan. A request for an amendment of records must be made in writing to the Privacy Official, c/o Michael D. Bauer (1603 East 27th Street, Cleveland, OH, 44114; Phone: 216-781-6420; Fax: 216-781-0398), and include the health information that you are requesting be amended as well as an explanation as to why you believe the health information is incorrect or incomplete.  The Plan may deny the request is it does not include a reason to support the amendment. The request also may be denied if your health information records were not created by the Plan, if the health information you are requesting to amend is not part of the Plan’s records, if the health information you wish to amend falls within an exception to the health information you are permitted to inspect and copy, or if the Plan determines the records containing your health information are accurate and complete. The Plan cannot amend health information that it did not create and will refer you to the provider of health care service if you requesting an amendment to diagnosis or treatment information. You have the right to an appeal if your request for an amendment is denied.

Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures of your health information of which the Plan is required to keep a record under the Privacy Rule, such as disclosures for purposes outside of treatment, payment or health care operations. The request must be made in writing to the Privacy Official, c/o Michael D. Bauer (1603 East 27th Street, Cleveland, OH, 44114; Phone:  216-781-6420; Fax: 216-781-0398), and include a statement explaining your specific request. The request should specify the time period for which you are requesting the information, but may not start earlier than April 14, 2003. Accounting requests may not be made for periods of time going back more than six (6) years. The Plan will provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee. The Plan will inform you in advance of the fee, if applicable.

Right to a Paper Copy of this Notice. You have a right to receive a paper copy of this Notice at any time, even if you have received this Notice previously or agreed to receive the Notice electronically. To Obtain a paper copy, please contact the Privacy Official, c/o Michael D. Bauer (1603 East 27th Street, Cleveland, OH, 44114; Phone: 216-781-6420; Fax: 216-781-0398).

DUTIES OF THE PLAN
The Plan is required by law to maintain the privacy of your health information as set forth in this Notice and to provide to you this Notice of its duties and privacy practices. The Plan is required to abide by the terms of this Notice, which may be amended from time to time. The Plan reserved the right to make the new Notice provisions effective for all health information that is maintains. If the Plan changed its policies and procedures, the Plan will revise the Notice to you within 60 days of the change. You have the right to file a complaint with the Plan and to the secretary or the Department of Health and Human Services if you believe that your privacy rights have been violated. Any complaints to the Plan should be made in writing to the Privacy Official. The Plan encourages you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.

CONTACT PERSON
The Plan has designated Michael D. Bauer as the Privacy Contact as its Cleveland office contact person for all issues regarding patient privacy and your privacy rights. You may contact him at 1603 East 27th Street, Cleveland, OH, 44114; Phone: 216-781-6420.

IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT Michael D. Bauer, THE PRIVACY CONTACT QT THE CLEVELAND FUND OFFICE AT 1603 EAST 27TH STREET, CLEVELAND, OH, 44114; PHONE: 216-781-6420

Employers Benefits

EFFECTIVE DATE

This notice is effective January 1, 2018.

 

The Ohio AFSCME Care Plan will reimburse 90% of the cost of prescription drugs paid by members and eligible dependents up to a maximum amount of $600.00 per calendar year.

IRS Form 1095-B, as applicable, is available upon request within 30 days of the request.

The request for the IRS Form can be sent to the Care Plan either by email at [email protected] or by mail to Ohio AFSCME Care Plan 1603 East 27^th Street, Cleveland, Ohio 44114.   

If you have any questions, you can contact the Care Plan office at 216-781-6420.