Consociate Notice of Privacy Practices
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.
The Health Insurance Portability and Accountability Act (HIPAA) requires that Consociate
protect the privacy of the personal health information (PHI) of its members. We
must also make the following information regarding our legal duties and privacy
practices available to you. If you wish to receive additional copies of this Notice,
they are available upon request. This Notice is effective 09/22/2010.
Permitted Uses of Your PHI
Consociate may use or disclose your PHI for the following purposes:
Treatment – the provision, coordination, or management of the health care
you receive by one or more doctors. Treatment also includes consultations between
two or more doctors, or your referral from one doctor to another.
For example, if you were to suffer a stroke, we may provide your PHI to a physical
therapist, to ensure you receive proper treatment.
Payment – Activities taken by Consociate to collect premiums or determine
or fulfill our responsibility for coverage and benefits under your plan. It also
includes activities by Consociate or your provider(s) to obtain or provide reimbursement
for the payment you receive.
For example, when you go to the doctor, your doctor will submit a claim to Consociate
in order to receive payment. Consociate may need to use or disclose PHI in order
to determine proper payment.
Health Care Business Operations – activities we do to maintain our company.
This includes activities such as:
- Conducting quality assessment and improvement
- Reviewing the qualifications of health care professionals
- Evaluating providers’ and our employees’ performance
- Conducting training programs
- Determining premiums or similar actions relating to creation or renewal of contracts
for health benefits
- Conducting medical review, legal services, and auditing functions (such as our Fraud
and Abuse Program)
- Business planning and development
- Business management and general administrative activities (such as resolving internal
complaints, and things we do to comply with the Privacy Rule)
For example, your PHI may be used to evaluate guidelines and procedures at Consociate
or our business partners, to improve them when possible. We may also provide your
PHI to our accountants, attorneys and others, to ensure we are following the laws
that apply to us.
Public Health Activities – We may disclose PHI to public health and government
agencies authorized by law to collect PHI. This would be done for purposes such
as reporting, controlling and preventing disease, injury, disability or vital events.
It can also include disclosures to:
- representatives of the Food and Drug Administration (FDA) or persons subject to
the FDA
- a person who may have been exposed to a communicable disease or condition, when
permitted by law
- an employer, if the PHI pertains to, a work-related illness or injury or work-related
medical surveillance
- a government agency authorized to receive reports of abuse, neglect, or domestic
violence, if we believe that such an instance has occurred.
Where Required by Law – We may disclose PHI where a state or federal law
or court requires us to do so.
Health Oversight Activities – We may disclose PHI to government agencies,
so they may monitor and maintain government benefit programs and other organizations
subject to government regulations.
Judicial and Administrative Proceedings - We may disclose PHI in the course
of a judicial or administrative proceeding in response to an order of a court or
administrative tribunal or in response to a subpoena, discovery request or other
lawful process, provided that certain requirements are met.
Law Enforcement Purposes – We may disclose PHI to a law enforcement official
when asked to do so by a court, subpoena or other request. We may also provide limited
PHI for the purpose of identifying or locating a suspect, fugitive, material witness,
or missing person. In some cases, we may also disclose PHI if it is suspected you
may have been the victim of a crime, or if we believe a crime has occurred on Consociate
premises and your PHI relates to the incident.
Decedents – We may disclose PHI to a coroner or medical examiner for identification,
determining a cause of death, and other similar activities. We may also disclose
PHI to funeral directors as necessary to carry out their duties with respect to
the decedent.
Organ Donation – We may disclose PHI to organizations involved in organ,
eye and tissue retrieval, storage, and transplantation, but only for those purposes.
Research – We may disclose PHI for medical research. This will only happen
if an appropriate review board approves the disclosure.
Averting a serious health threat – We may disclose PHI if we believe it is
necessary to prevent or lessen an immediate threat to you, another individual or
the health of the public.
Specialized government functions – We may disclose PHI for national security
reasons. We may also disclose PHI for certain military and veteran’s activities,
as well as correctional institutions.
Enrollment/Disenrollment – We may disclose your PHI to your employer or their
representative if it relates to your (or your dependents’) enrollment or disenrollment
from the plan.
Friends and Family Members – We may disclose PHI to your family members,
relatives, personal friends or other individuals under the following circumstances:
- If you give us permission to do so
- To notify your representative or other person involved in your care of your location,
general condition or death
- When you are incapacitated, not present, or in emergency circumstances, if we have
reason to believe that the disclosure is in your best personal interest
- We may disclose your information to public or private groups in the disaster relief,
in order to notify or locate a relative or other individual involved in your care.
De-identified Information – We may use your PHI to create de-identified information.
This is information which may pertain to you, but does not identify you.
Health-related benefits or services – We may use PHI to send you information
about other health care treatment, services, or benefits.
Other Uses of Your PHI
Consociate will not use or disclose your PHI for any other purpose unless we have
your written permission to do so. If we want your permission, we will give you an
Authorization Agreement. It will explain our request. You are not required to sign
it. If you do sign it, and later want to revoke your authorization, you may do so
in writing. Please direct your letter to the Privacy Officer, at the address below.
State Restrictions
Illinois state law also imposes restrictions on how we use your PHI. Generally,
Consociate may not disclose any PHI regarding your diagnosis, treatment, or health
without your consent. We may disclose PHI without your consent to comply with state
law, in response to a claim or litigation, to implement public medical assistance
programs, and when disclosure of PHI is required by law.
Genetic Information – Consociate will not disclose your genetic information
without your prior written authorization. We will not require you to disclose the
genetic information of you or your dependents.
Mental Health Records – Records relating to the mental health treatment and
legal proceedings concerning patients or residents of mental institutions are confidential.
They generally may not be disclosed without consent of the patient or guardian.
Disclosure is permitted to carry out treatment or commitment of the individual,
upon court order, and in some law enforcement circumstances. Disclosure is also
permitted, upon proper inquiry, of information as to the current medical condition
of a patient or resident to any member of the patient’s family.
Organ Transplants – Records containing the source of body parts for transplantation
or any information concerning persons donating body parts for transplantation are
confidential. They are not open to public inspection.
Member Rights
This section explains some of your rights regarding your access to your PHI.
Right to Request Restrictions – You have the right to request restrictions
in how your PHI may be used or shared with others regarding Treatment, Payment,
and Business Operations. Your request must be in writing. Please direct your request
to the Privacy Officer, at the address below. Consociate is not legally required
to agree to your request. If we agree to your request, that agreement will be binding.
Right of Access – You have a limited right to obtain and inspect a copy or
receive a summary or oral description of a file that contains your PHI. If you want
to do this, your request must be in writing. Please direct your request to the Privacy
Officer, at the address below. Once we receive your request, a determination will
be made within thirty (30) days. If we approve your request, a small fee based on
your request will be charged for this service.
Right to Receive a Confidential Communication – If you believe that receiving
your PHI at your home address could endanger you, you have the right to request
that any communication be sent to an alternate location. You may also receive your
information by other means. Please include this information with your written request
to the Privacy Officer at the address below.
Right to Amend – If you believe that PHI created and maintained by Consociate is
incorrect, you have the right to request that it be amended. Your request must be
in writing. It must include the reason you wish it to be amended. Please direct
your request to the Privacy Officer, at the address below. Once we receive your
request, a determination will be made within sixty (60) days.
Right to Accounting of Disclosures – You have a limited right to receive
a report of the instances in which we have disclosed your PHI for any purpose other
than Treatment, Payment, Health Care Business Operations or disclosures we make
pursuant to your authorization, as explained in this Notice. You may not request
an accounting of disclosures made more than six years prior to your request. All
requests must be in writing. Please specify the exact time frame you want the account
to include. Please direct your request to the Privacy Officer, at the address below.
The first report processed for you within a twelve (12) month period will be done
without charge. A small fee based on your request will be charged for additional
reports within the same twelve (12) month period.
Right of Complaint – If you believe your privacy rights have been violated,
you have the right to register a complaint with us or the Department of Health and
Human Services. If you wish to register a complaint with Consociate, you should
submit this complaint in writing to the Privacy Officer at the address below. No
action will be taken against you for filing a complaint.
Any written requests concerning your rights explained above should be sent to:
Privacy Officer
Consociate
P.O. Box 1068
Decatur, IL 62525
Use of E-Mail
We appreciate your questions and comments about our website and services and welcome
your email messages to mailboxes listed on our web sites. We will share your messages
with those within our organization that are most capable of addressing the issues
contained in your message. We preserve the content of your e-mail, your e-mail address
and our response so that we can efficiently respond to questions you might have.
We also do this in an effort to meet legal and regulatory requirements. We will
respect your request not to be contacted by e-mail.
Please use your best judgment when sending information via the Internet to an e-mail
address. E-mail sent via the Internet may pass through private and public networks
with varying levels of security. Some networks may have taken steps to secure e-mail
transmissions while others have not, thereby compromising the privacy and integrity
of an e-mail. An e-mail may be copied, altered or destroyed. You may always convey
confidential, personal or sensitive information more securely by calling the appropriate
service phone number that you will find under Contact Us.
Links to Other Websites
This website may feature links to other websites owned and operated by third parties.
Be advised that Consociate is not responsible for the content or services of these
third party sites. Privacy Policies, if any, of these third party sites may differ
from Consociate’s Privacy Policy. We encourage you to read the Privacy Policy of
any website you visit.
Changes to Our Website Privacy Notice
Consociate is required to follow the terms of this Notice. Please note that we reserve
the right to make changes to this Notice and the terms of the new notice will apply
to all PHI that we maintain. If any changes are made, we will provide you a revised
copy, via mail. If you wish to receive a copy of this Notice, or any future revisions
electronically, please contact our Customer Service Department at the telephone
number(s) above. Receiving a Notice electronically will not affect your right to
receive a paper copy.
Contacting Us
For further explanation of the information contained in this Notice, please contact
the Customer Service Department. Our representatives may be reached at 217-423-7788
(locally) or 1-800-798-2422 (toll-free).