Your
Privacy Matters
In compliance with the
Health Insurance Portability and Accountability Act (HIPAA), Coventry
HealthCare is sending you important information about how your medical and
personal information may be used and about how you can access this
information. Please review the Notice of Privacy Practices carefully. If you
have any questions, please call the Member Services number on the back of
your membership identification card.
Notice of Privacy
Practices
Effective: 4/14/2003 (Revised 1/1/2011)
THIS NOTICE DESCRIBES HOW MEDICAL AND
PERSONAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET
ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
A. Our Commitment to Your Privacy
We understand the
importance of keeping your personal and health informationii
secure and private.
We are required by law
to provide you with this notice. This notice informs you of your rights about
the privacy of your
personal information and how we may use and share your personal information.
We will make sure that
your personal information is only used and shared in the manner described.
We may, at times,
update this notice. Changes to this notice will apply to the information that
we already have about you as well as any information that we may receive or
create in the future. Our current notice is posted at www.cvty.com. You may
request a copy at any time. Throughout this notice, examples are provided.
Please note that all of these examples may not apply to the services Coventry provides to
your particular health benefit plan.
B. What Types of Personal Information Do We Collect?
To best service your
benefits, we need information about you. This information may come from you,
your employer, or other payors or health benefits
plan sponsors, and our affiliates. Examples include your name, address, phone
number, Social Security number, date of birth, marital status, employment
information, or medical history. We also receive information from health care
providers and others about you. Examples include the health care services you
receive. This information may be in the form of health care claims and
encounters, medical information, or a service request. We may receive your
information in writing, by telephone, or electronically.
C. How Do We Protect the Privacy of Your Personal Information?
Keeping your
information safe is one of our most important duties. We limit access to your
personal information to those who need it. We maintain appropriate safeguards
to protect it. For example, we protect access to our buildings and computer
systems. Our Privacy Office also assures the training of our staff on our
privacy and security policies.
D. How Do We Use and Share Your Information for Treatment,
Payment, and Health Care Operations?
To properly service
your benefits, we may use and share your personal information for
“treatment,” “payment,” and “health care operations.” Below we provide examples
of each. We may limit the amount of information we share about you as
required by law. For example, HIV/AIDS, substance abuse, and genetic
information may be further protected by law. Our privacy policies will always
reflect the most protective laws that apply.
• Treatment: We may use and share your personal information
with health care providers for coordination and management of your care.
Providers include physicians, hospitals, and other caregivers who provide
services to you.
• Payment: We may use and share your personal information to
determine your eligibility,
coordinate care,
review medical necessity, pay claims, obtain external review, and respond to
complaints. For example, we may use information from your health care
provider to help process your claims. We may also use and share your personal
information to obtain payment from others that may be responsible for such
costs.
• Health care operations: We may use and share your personal
information as part of our operations in servicing your benefits. Operations
include credentialing of providers; quality improvement activities;
accreditation by independent organizations; responses to your questions, or
grievance or external review programs; and disease management, case
management, and care coordination. We may also use and share information for
our general administrative activities such as pharmacy benefits
administration; detection and investigation of fraud; auditing; underwriting
and rate-making; securing and servicing reinsurance policies; or in the sale,
transfer, or merger of all or a part of a Coventry company with another
entity. For example, we may use or share your personal information in order
to evaluate the quality of health care delivered, to remind you about
preventive care, or to inform you about a disease management program.
We may also share your
personal information with providers and other health plans for their
treatment, payment, and certain health care operation purposes. For example,
we may share personal information with other health plans identified by you
or your plan sponsor when those plans may be responsible to pay for certain
health care benefits.
E. What Other Ways Do We Use or Share Your Information?
We may also use or
share your personal information for the following:
• Medical home / accountable
care organizations: Coventry may work with your primary care physician,
hospitals and other health care providers to help coordinate your treatment
and care. Your information may be shared with your health care providers to
assist in a team-based approach to your health.
• Health care oversight and law enforcement: To comply with federal
or state oversight
agencies. These may
include, but are not limited to, your state department of insurance or the
U.S. Department of Labor.
• Legal proceedings: To comply with a court order or other lawful
process.
• Treatment options: To inform you about treatment options or
health-related benefits or services.
• Plan sponsors: To permit the sponsor of your health benefit
plan to service the benefit plan and your benefits. Please see your
employer’s plan documents for more information.
• Research: To researchers so long as all procedures required by law
have been taken to protect the privacy of the data.
• Others involved in your health care: We may share certain
personal information with a relative, such as your spouse, close personal
friend, or others you have identified as being involved in your care or
payment for that care. For example, to those individuals with knowledge of a
specific claim, we may confirm certain information about it. Also, we may
mail an explanation of benefits to the subscriber. Your family may also have
access to such information on our Web site. If you do not want this
information to be shared, please tell us in writing.
• Personal representatives: We may share personal information with
those having a relationship that gives them the right to act on your behalf.
Examples include parents of an unemancipated minor
or those having a Power of Attorney.
• Business associates: To persons providing services to us and who
assure us that they will protect the information. Examples may include those
companies providing your pharmacy or behavioral health benefits.
• Other situations: We also may share personal information in
certain public interest situations.
Examples include
protecting victims of abuse or neglect; preventing a serious threat to health
or safety; tracking diseases or medical devices; or informing military or
veteran authorities if you are an armed forces member. We may also share your
information with coroners; for workers’ compensation; for national security;
and as required by law.
F. What About Other Sharing of Information and What Happens If
You Are No Longer Enrolled?
We will obtain your
written permission to use or share your health information for reasons not
identified by this notice and not otherwise permitted or required by law. If
you withdraw your permission, we will no longer use or share your health
information for those reasons.
We do not destroy your
information when your coverage ends. It is necessary to use and share your
information, for many of the purposes described above, even after your
coverage ends. However, we will continue to protect your information
regardless of your coverage status.
G. Rights Established by Law
• Requesting restrictions: You can request a restriction on the
use or sharing of your health information for treatment, payment, or health
care operations. However, we may not agree to a requested restriction.
• Confidential communications: You can request that
we communicate with you about your health and related issues in a certain
way, or at a certain location. For example, you may ask that we contact you
by mail, rather than by telephone, or at work, rather than at home. We will
accommodate reasonable requests.
• Access and copies: You can inspect and obtain a copy of certain
health information. We may charge a fee for the costs of copying, mailing,
labor, and supplies related to your request. We may deny your request to
inspect or copy in some situations. In some cases denials allow for a review
of our decision. We will notify you of any costs pertaining to these
requests, and you may withdraw your request before you incur any costs. You
may also request your health information electronically and it will be
provided to you in a secure format.
• Amendment: You may ask us to amend your health
information if you believe it is incorrect or incomplete. You must provide us
with a reason that supports your request. We may deny your request if the
information is accurate, or as otherwise allowed by law. You may send a
statement of disagreement.
• Accounting of disclosures: You may request a report of certain
times we have shared your information. Examples include sharing your
information in response to court orders or with government agencies that
license us. All requests for an accounting of disclosures must state a time
period that may not include a date earlier than six years prior to the date
of the request and may not include dates before April 14, 2003. We will
notify you of any costs pertaining to these requests, and you may withdraw
your request before you incur any costs.
H. To Receive More Information or File a Complaint
Please contact Member
Services to find out how to exercise any of your rights listed in this
notice, or if you have any questions about this notice. The telephone number
or address is listed in your benefit documents or on your membership card. If
you believe we have not followed the terms of this notice, you may file a
complaint with us or with the Secretary of the Department of Health and Human
Services. To file a complaint with the Secretary, write to 200 Independence Avenue, S.W. Washington, D.C. 20201 or call 1-877-696-6775. You
will not be penalized for filing a complaint. To contact us, please follow
the complaint, grievance, or appeal process in your benefit documents.i
For purposes of this
notice, the pronouns "we", "us" and "our" and
the name "Coventry" refers to Coventry Health Care, Inc. and its
licensed affiliated companies, including, but not limited to, Altius Health Plans, Inc.; Cambridge Life Insurance
Company; Carelink Health Plans, Inc.; Coventry
Health Care of Delaware, Inc.; Coventry Health Care of Florida, Inc.,
Coventry Health Plan of Florida, Inc.: Coventry Health Care of Georgia, Inc.;
Coventry Health Care of Iowa, Inc.; Coventry Health Care of Nebraska, Inc.;
Coventry Health Care of Pennsylvania, Inc.; Coventry Health Care of
Louisiana, Inc.; Coventry Health and Life Insurance Company; Coventry Health
Care of Kansas, Inc.; Coventry Health Care National Accounts, Inc.; Coventry
Summit Health Plan, Inc First Health Life & Health Insurance Company;
First Health Services Corp.; Group Dental Services, Inc.; Group Health Plan,
Inc.; HealthAmerica Pennsylvania, Inc., HealthAssurance
Pennsylvania, Inc., HealthCare USA of Missouri, L.L.C.; Kansas Health Plan,
Inc.; Mercy Health Plans; MHP, Inc.; MHNet
Specialty Services, LLC.; MHNet of Florida, Inc.; MHNet Life and Health Insurance Company; Mental Health
Associates, Inc.; Mental Health Network of New York IPA, Inc.; OmniCare Health Plan, Inc.; PersonalCare
Insurance of Illinois, Inc.; Preferred Benefits Administrator, Inc.;
Preferred Health Care, Inc.; Preferred Health Systems, Inc.; Preferred Health
Systems Insurance Company; Preferred Plus of Kansas, Inc.; Southern Health
Services, Inc.;and WellPath
Select, Inc. These entities abide by the privacy practices described in this Notice.ii
Under various laws,
different requirements can apply to different types of information.
Therefore we use the term "health information" to mean
information concerning the provision of, or payment for, health care that is
individually identifiable. We use the term "personal information"
to include both health information and other nonpublic identifiable
information that we obtain in providing benefits to you.