Notice of Privacy Practices

This notice describes how medical informaiton about you may be used and disclosed and how you can get access to this informaiton. Please review the notice carefully.

Millikin University sponsors multiple group health Plans(s), which include a Health Plan, a Flexible Spending Account Plan, and an Employee Assistance Plan.  These Plans are “Health Plans” for purposes of the Privacy Rule adopted under the Health Insurance Portability and Accountability Act of l996 (HIPAA).  These Plans are also an organized health care arrangement and this Notice is being provided by all three Plans.  References in this Notice to “our”, “us” or “we” will mean all or any one of the Plans listed above.

We maintain a record of your enrollment information and enrollment status as a participant in one or more of the Plans.  We may also receive information from you or your health care providers regarding your claims, payment of your claims, your medical condition and the medical services you receive.  We need this information to operate the Plans.  This Notice describes our privacy policy and applies to all information that we create or receive that identifies you, or that could be used to identify you, and that relates to your health, your treatment or your payment for health care.  We will refer to this information in this Notice as your “protected health information” or “PHI”.

Our obligations

We are required by law to take reasonable steps to maintain the privacy of your PHI whether the information is verbal, written, or electronic.  

We are also required to provide you with this Notice about our uses and disclosures of your PHI, our legal duties with respect to your PHI and your rights with respect to your PHI.  This notice takes effect on April 14, 2004 and will remain in effect until we replace it.  We must follow the privacy practices described in this Notice for so long as it is in effect.  We reserve the right to change the terms of this Notice and to apply the new terms to all the PHI we maintain, including PHI created or received before wechange this Notice.  If we do change this Notice, and if you are still covered by at least one of the Plans, we will mail you a new Notice within 60 days after the effective date of the revision.

How we may use and disclose your private healthcare informaiton

Required Uses and Disclosures:

We may be required to use and disclose your PHI to the Department of Health and Human Services so that the Department may determine whether we are complying with the Privacy Rule.  
We may also disclose your PHI if required to do so by a federal, state or local law.

Permitted Uses and Disclosures:

We are permitted to use PHI and to disclose PHI for purposes related to treatment, payment and health care operations. Treatment refers to providing, coordinating or managing your health care and related services.  For example, we may disclose PHI to a physician who is treating you.

Payment includes coverage determinations, claims administration, and coordination of benefits with other coverage you may have.  For example, we may tell a physician whether you are eligible for coverage or what portion of a bill that we will pay.        

Health Care Operations includes quality assessment and improvement activities, reviewing the competence of qualification of health care professionals, business planning and management, premium rating and other activities related to creating or renewing insurance contracts, case management, disease management, conductingor arranging for medical review, legal services and auditing functions such as to detect health care fraud and abuse and general administrative activities.  For example, we may use information about your claims and claims of other participants to project future costs of benefits.

We may also use and disclose PHI for the following reasons and purposes:

  • For certain law enforcement purposes, such as to identify or locate a suspect, material witness, or missing person or to report a crime;
  • In connection with a lawsuit or other dispute, if we receive an appropriate court or administrative order or if we receive a subpoena, discovery request or other lawful process and the persons seeking the information have made efforts to tell you about the request or to obtain a court order protecting the confidentiality of the information requested;
  • For public health activities such as:
    • to report health information to public health authorities that are authorized by law to receive such information for the purpose of preventing or controlling diseases, injury or disability;
    • to report abuse, neglect or domestic violence to a government authority that is authorized by law to receive such reports;
    • to report information about a product defect or to permit product recalls as in the case of the quality, safety or effectiveness of a product regulated by the U. S. Food and Drug Administration;
    • to alert a person who may have been exposed to a communicable disease if the Plan is authorized by law to give such notice;
  • To government agencies responsible for public health oversight activities or for ensuring compliance with rules of government benefit programs such as Medicare or Medicaid;
  • To the plan sponsor if the PHI disclosed is limited to whether you are a participant and your enrollment information.  If the plan sponsor requests PHI for purposes of obtaining bids from insurers or modifying or terminating the plan, we may disclose your PHI to the plan sponsor if we remove certain identifying information.  If the plan sponsor provides us with any administrative services and needs PHI to perform those services, we may disclose PHI for that purpose if the plan documents are amended to restrict the plan sponsor’s use and disclosure of PHI;
  • To contact you regarding one or more of the plans, to obtain additional information about a claim or payment or to tell you about treatment options or alternatives or other health related benefits or services that may be of interest to you;
  • To persons we contract with to perform a service to us, if the service provider agrees in writing to the same limits on the use and disclosure of PHI that apply to us; this would apply, for example, to our third party administrators;
  • To a coroner, medical examiners or funeral director;
  • To Workers’ Compensation, as authorized by and/or necessary to comply with such laws;
  • If there is a family member, relative, friend or other person identified by you who is involved with your care or payment related to your care, we may disclose relevant PHI to that person. Generally we must obtain your agreement, give you an opportunity to object, or reasonably determine that you do not object or that the disclosure is in your best interest.  For example, we might reasonably determine that you would not object to our discussion of your claim with your spouse;
  • If you are an inmate of a correctional institution or in the custody of a law enforcement official, to the correctional institution or official; 
  • To avoid a serious threat to your health and safety or the health and safety of the public;
  • Under certain circumstances, we may use and disclose your PHI for research purposes;
  • To create a limited data set, and use and disclose that limited data set, subject to the requirements of the Privacy Rule (a limited data set is PHI that has had certain identifying information removed);
  • disclosures that are incidental to use and disclosure by us that is otherwise permitted or required by the Privacy Rule.

Our use or disclosure of certain specific types of health information may be more restricted under other federal law or under state law.  For example, our use and disclosure of HIV testing information, alcohol and drug treatment information or mental health information are subject to special rules that may be more protective of your privacy.

Authorized Uses and Disclosures

We may use or disclose your PHI for other purposes only when you give a written authorization to do so.  Your authorization must comply with the requirements of the Privacy Rule.  You may obtain an authorization form by contacting the person named at the end of this Notice.  You make revoke an authorization at any time by delivering a written statement of revocation to the person named at the end of this Notice.  The revocation will not apply to authorized actions we took while the authorization was in effect, or if the authorization relates to insurance, to the insurers right under other law to contest a claim.

Your rights

You have the following rights regarding your medical information, provided that you make a written request to invoke the right.

Right to Request Additional Restrictions

You may request restrictions on our use and disclosure of your PHI for treatment, payment and health care operations.  You may also request a limit on the PHI we disclose to someone who is involved in your care or the payment of your care, like a family member or friend.  We are not required to agree to your request.  If you wish to request additional restrictions, obtain, complete and submit a restriction request form to the person named at the end of this Notice.

Right to Receive Confidential Communications

We will accommodate a reasonable request for you to receive your PHI by alternative means of communication or at alternative locations, such as a post office box instead of your home address, if your request clearly states that disclosure of that information could endanger you.

Right to Inspect and Copy your PHI

You have a right to inspect and copy your PHI for so long as we maintain it. This applies to PHI maintained in the enrollment, payment, claims adjudication and case or medical management record systems maintained by or for us or used by us to make decision about individuals, but does not include certain information excluded by the Privacy Rule.  Under limited circumstances, we may deny you access to a portion of your records.  If we deny your request, you may be entitled to request that the denial be reviewed and we will comply with the results of that review.  If you wish to access your records, your request must be in writing. Please obtain, complete and submit a request record form to the person named at the end of this Notice.  If you request copies, we will charge you copying and mailing costs.

Right to Amend Your Records

You have the right to request that we amend your PHI maintained in the enrollment, payment, claims adjudication and case or medical management record systems maintained by or for the Plan and any other records used by or for us to make decisions about individuals. Your request to amend your records must be made in writing and must include a reason for the amendment.  To make such a request, please obtain, complete and submit a request form from the person named at the end of this Notice.  We may deny your request to amend your records if you ask us to amend information that was not created by us, unless the person that created the information is no longer available to make the amendment; it is not part of the information that you would be entitled to inspect and copy; or the information is accurate and complete.

Right to Receive An Accounting of Disclosures

Upon request, you may obtain an accounting of certain disclosures of your PHI made by us.  Your request for an accounting of disclosures must be made in writing and must state the time period that you want the accounting to cover.  This period may be up to six years before your request, but may not include dates before April 14, 2004.  To make a request, please obtain, complete and submit a request form to the person named at the end of this Notice.  If you request an accounting more than once during a twelve (12) month period, we will charge you a reasonable fee for the second and any subsequent statements.  The accounting will not include disclosures of your PHI made to carry out treatment, payment or health care operations activities, disclosures made to you or pursuant to your written authorization, and other disclosures not subject to the accounting requirement.

Right to Receive Paper Copy of this Notice

Upon request, you may obtain an additional paper copy of this Notice by contacting the person named at the end of this Notice.  You may exercise any of the above rights through a personal representative who will be required to produce evidence of his or her authority to act on your behalf.  You may also view this Notice on our website at www.millikin.edu.

Conclusion

Our use and disclosure of your PHI is regulated by the Privacy Rule adopted under the Health Insurance Portability and Accountability Act (HIPAA).  You may find these rules at 45 Code of Federal Regulations Parts 160 and 164.  We are also subject to other federal and Illinois laws that may apply to our use or disclosure of your PHI.  This Notice attempts to summarize the rules.  In the event of a discrepancy between the information in this Notice and the rules, the rules will supercede this Notice.

Complaints

If you are concerned that we have violated your privacy rights you may file a complaint by contacting the person named at the end of this Notice.  All complaints to us must be submitted in writing. You may also file a written complaint with the Secretary of the U.S. Department of Health and Human Services, 233 N. Michigan Ave., Suite 240, Chicago, IL 60601. We support your right to the privacy of your PHI and will not retaliate against you if you file a complaint.  

Contact information

If you have any questions regarding this Notice, or if you wish to obtain any of the forms referred to in this Notice, you may contact:

                Director of Human Resources
                Millikin University
                1184 W. Main St.
                Decatur, IL  62522-2084
                Phone:  (217) 362-6416
                Fax:  (217) 362-6468
                E-mail:  dlane@millikin.edu

 

                 Effective Date: April 14, 2004