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NOTICE OF
PRIVACY PRACTICES AND POLICIES
This notice is in effect as of April 14, 2003
In Compliance with Title V of the GRAMM-LEACH-BLILEY ACT (GLBA) and
associated state laws and in accordance with our contractual
obligations to various COVERED ENTITIES as BUSINESS ASSOCIATES under
Federal Laws pertaining to privacy of personally-identifiable health
information and protected health information under regulations
relating to the Health Insurance Portability and Accountability Act
of 1996 (HIPAA), we are providing you with this document, which
notifies you of the privacy policies and practices of
BLUE RIDGE BENEFIT SOLUTIONS, INC..
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.
1.
Statement of Our Duties.
We are required by law to maintain the privacy of
your personally identifiable health and nonpublic personal
information and to provide you with this notice of our privacy
practices and legal duties. We are required to abide by the terms of
this notice. We reserve the right to change the terms of this notice
and to adopt any new provisions regarding the personal health
information that we maintain about you. If we revise this notice, we
will provide you with a revised notice by mail or hand delivery.
2.
Statement of Your Rights.
You have a right to know how we may use or disclose
your personal health information. This notice informs you of those
uses and disclosures. There are certain uses and disclosures of your
personal health information that we are permitted or required to
make under law without your permission. For all other uses and
disclosures, we first must obtain your permission. In addition, you
have the following rights:
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The right to request that we place additional restrictions on our
uses and disclosures of your personal health information. However,
we are not obligated to agree to impose any such additional
restrictions.
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The right to access, inspect and copy the protected information
pertaining to you that we maintain in our files about you, and the
right to have us correct or amend any information that we create in
error. Requests to access or amend your health information should be
sent to the contact person and address provided in Paragraph 8
below.
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The right to receive an accounting of the disclosures of your
personal health information that we make for purposes other than
activities related to your treatment, or our payment functions or
other health care operations.
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The right to request that you receive communications of personal
health information in a confidential manner.
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If you received this notice electronically, you also have the right
to obtain a paper copy of this notice from us on request.
3.
Information We Collect About You.
We collect the following categories of
information about you from the following sources:
a) Information that we obtain directly from you, in conversations or
on applications or other forms that you fill out.
b) Information regarding current or prospective plan participants we
obtain about them on applications or other forms.
c) Information about the plan’s transactions with our affiliates,
others or us.
d) Information that we obtain as a result of our transactions with
you.
4.
Permissible Uses and Disclosures of Protected Information.
We disclose the information we receive regarding current or
prospective plan participants only in accordance with the terms and
conditions of the various Business Associate contracts we have
entered to with Covered Entities under HIPAA Privacy Regulations and
as permitted under state and federal laws concerning the privacy of
your insurance and financial information. Those include:
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Situations Permitted or Required by Law . We also may use or
disclose your protected health information without your written
permission for other purposes permitted or required by law,
including the following:
a) As authorized by and to the extent necessary to comply with
workers’ compensation or other no-fault laws;
b) To an oversight or insurance regulatory agency for activities
including audits or civil, criminal or administrative actions;
c) To a public health authority for purposes of public health
activities (such as to the
Federal Food and Drug Administration to report consumer product
defects);
d) To a law enforcement official for law enforcement purposes or in
response to a court order or in the course of any judicial or
administrative proceeding;
e) To organ procurement organizations or other entities for approved
research; or
f) To a governmental authority, including a social service or
protective services agency, authorized to receive reports of abuse,
neglect or domestic violence.
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For any Purposes to Which you have Not Objected. In certain limited
circumstances, we may use or disclose your protected health
information after we have given you an opportunity to object and you
have not objected. For example, if you do not object, we may use
limited information about you to maintain an office directory, to
notify family members or any other person identified by you
regarding issues directly related to such person’s involvement with
your care or payment for that care, or in emergency circumstances.
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For Purposes for Which We Have Obtained your Written Permission. All
other uses or disclosures of your protected health information will
be made only with your written permission, and you may revoke any
permission that you give us at any time.
5.
COMPLAINTS
ABOUT
M
ISUSE OF HEALTH
INFORMATION.
You may complain either directly to us or to the Secretary of Health
and Human Services if you believe that your rights with respect to
our protection of your health information have been violated. To
file a complaint with us, you may send a written statement outlining
your complaint, the facts and circumstances surrounding your
complaint, including the names, dates and as many details as
possible. You will not be retaliated against in any way for filing a
complaint.
6.
Our Practices Regarding Confidentiality and Security.
We restrict access to nonpublic personal and personally-identifiable
health information about you to those employees and agents who need
to know that information in order to provide products and services
to you. We maintain physical, electronic and procedural safeguards
that comply with state & federal regulations to guard your nonpublic
personal information.
7.
Our Policy Regarding Dispute Resolution.
Any controversy or claim arising
out of or relating to our privacy policy, or the breach thereof,
shall be settled by arbitration in accordance with the rules of the
American Arbitration Association, and judgment upon the award
rendered by the arbitrator(s) may be entered in any court having
jurisdiction thereof.
8.
Contact Person for Filing Complaint or Obtaining Other Information.
Our contact is:
PRIVACY OFFICER
Blue Ridge Benefit Solutions, Inc.
Post Office 3045
Asheville, North Carolina 28802
(828) 285-9957
(828) 259-9525 facsimile
© 2003 Davis Bibbs & Smith, PLLC
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