HIPAA Privacy Policy

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL/PROTECTED HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Ultimate Health Plans, Inc. is a covered entity under HIPAA law. This notice applies to the privacy practices that govern Ultimate Health Plans in disclosing and sharing your Protected Health Information (PHI) as needed for treatment, payment and health care operations.

Our Commitment Regarding Your Protected Health Information (PHI)

We understand the importance of your Protected Health Information (hereafter referred to as “PHI”) and follow strict policies (in accordance with state and federal privacy laws) to keep your PHI private. PHI is information about you, including demographic data, that can reasonably be used to identifies you and that relates to your past, present or future physical or mental health, the provision of health care to you, or the payment for that care.

In this notice, we explain how we protect the privacy of your PHI, and how we will allow it to be used and given out (“disclosed”). We are required to provide you with a summary of our Notice of Privacy Practices, and a copy of the Notice of Privacy Practices upon request. We must follow the privacy practices described in this notice while it is in effect.

We reserve the right to change our privacy practices and the terms of this notice at any time, provided that applicable law permits such changes. These revised practices will apply to your PHI regardless of when it was created or received. Before we make a material change to our privacy practices, we will provide you with a revised Notice of Privacy Practices.

Where multiple state or federal laws protect the privacy of your PHI, we will follow the requirements that provide the greatest privacy protection. For example, when you authorize disclosure to a third party, state law requires us to condition the disclosure on the recipient’s promise to obtain your written permission to disclose to someone else.

Our Uses and Disclosures of Protected Health Information

We do not sell your PHI to anyone or disclose your PHI to other companies who may want to sell their products to you.

We must have your written authorization to use and disclose your PHI, except for the following uses and disclosures:

• To You:

  We may disclose your PHI to you, for example:

  • Supplying you with information about your diagnosis or treatment.
  • Communicating with you about treatment alternatives or other health-related benefits and services.
• For Treatment:

  We may use and disclose your PHI to health care providers and our business associates who request PHI in connection with your diagnosis, treatment, management of your care, coordination of benefits, and insurance eligibility, for Example:

  • Physicians and physician’s assistants
  • Nurses
  • Dentists
  • Audiologists
  • Speech-language pathologists
  • Physical or occupational therapists
  • Psychologists
  • Pharmacies
  • Hospitals
  • Nursing homes
  • Hearing instrument manufacturers
  • Augmentative communication device manufacturers

For example, we may disclose your PHI to health care providers in connection with:

• Disease and case management programs
• Prescribing medications
• Ordering lab work or diagnostic imaging at an outside facility
• Referring you to an outside provider and informing him/her of your medication allergies
• Providing emergency medical treatment
• Orders and service for hearing instruments and augmentative communication devices
• Services related to speech, language, swallowing, or hearing disorders
• Other health care services
• For Payment:

  We may use and disclose your PHI for our payment-related activities and those of health care providers, including, for example:

  • Obtaining premiums and determining eligibility for benefits
  • Paying claims for health care services that are covered by Ultimate Health Plans
  • Responding to inquiries, appeals and grievances
  • Coordinating benefits with other insurance you may have
  • Submitting a claim form on your behalf
• For Health Care Operations:

  We may use and disclose your PHI for the following health care operations, for example:

  • Conducting quality assessment and improvement activities, including peer review, credentialing of providers, and accreditation
  • Auditing billing processes
  • Performing outcome assessments and health claims analyses
  • Preventing, detecting and investigating fraud and abuse
  • Underwriting, rating and reinsurance activities
  • Coordinating case and disease management activities
  • Performing business management and other general administrative activities, including systems management and member service
  • Scheduling appointments and keeping records

We may also disclose your PHI to other providers and health plans who have a relationship with you for their health care operations. For example, we may disclose your PHI for their quality assessment and improvement activities or for health care fraud and abuse detection.

• To Others Involved in Your Care:

We may disclose your PHI to someone who has the legal right to act on your behalf. We may under certain circumstances disclose to a designated contact person (e.g., a member of your family, a relative, a close friend or any other person you identifies), the PHI directly relevant to that person’s involvement in or payment for your health care. For example, we may discuss a claim determination with you in the presence of a friend or relative, unless you object.

• When Required by Law:

  We will use and disclose your PHI if we are required to do so by law. For example, we will use and disclose your PHI:

  • To report infectious diseases
  • To respond to court and administrative orders and subpoenas
  • To comply with workers’ compensation laws
  • To report congenital hearing losses in infants and children
  • To report occupational noise induced hearing loss
  • To report suspected abuse and neglect to the proper authorities
  • To report PHI as required by the Centers for Medicare and Medicaid Services (CMS) and state regulatory authorities
• For Matters in the Public Interest:

  We may use or disclose your PHI without your written permission for matters in the public interest, including for example:

  • Public health and safety activities, including Food and Drug Administration oversight, reporting disease and vital statistics.
  • Averting a serious threat to the health or safety of others, (e.g., as required under the Patriot Act
• For Research:

We may use your PHI to perform select research activities, provided that certain established measures to protect your privacy are in place, as required by Institutional Review Board regulations created and monitored by the National Institutes of Health.

• To Our Business Associates:

From time to time we engage third parties to provide various services for us. Whenever an arrangement with such a third party involves the use or disclosure of your PHI, we will have a written contract with that third party designed to protect the privacy of your PHI. For example, we may share your information with business associates who process claims or conduct disease management programs on our behalf.