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C-P FLEXIBLE
PACKAGING, INC. EMPLOYEE BENEFIT PLAN HIPAA NOTICE
OF PRIVACY PRACTICES - Effective
Date: 4/14/2004
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.
IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE, PLEASE
CONTACT THE C-P FLEXIBLE PACKAGING, INC. EMPLOYEE BENEFIT PLAN
PRIVACY OFFICER (Nancy Schrum) THROUGH THE HUMAN RESOURCES
DEPARTMENT.
Protected Health Information (PHI) is information,
including demographic information, that may identify you and
that relates to health care services provided to you, the
payment of health care services provided to you, or your
physical or mental health or condition, in the past, present
or future. This Notice of Privacy Practices describes how we
may use and disclose your PHI. It also describes your rights
to access and control your PHI.
As a group health plan we are required by Federal law to
maintain the privacy of PHI and to provide you with this
notice of our legal duties and privacy practices.
We are required to abide by the terms of this Notice of
Privacy Practices, but reserve the right to change the Notice
at any time. Any change in the terms of this Notice will be
effective for all PHI that we are maintaining at that time. If
a change is made to this Notice, a copy of the revised Notice
will be provided to all individuals covered under the C-P
Flexible Packaging, Inc. Employee Benefit Plan at that time.
PERMITTED USES AND DISCLOSURES
Treatment, Payment and Health Care Operations Other
Uses and Disclosures Allowed Without Authorization
Federal law also allows a group health plan to use and
disclose PHI, without your consent or authorization, in the
following ways:
Treatment. Treatment refers to the
provision and coordination of health care by a doctor,
hospital or other health care provider. As a group health plan
we do not provide treatment; however, we may disclose your
PHI, for example, the name of your treating dentist, to a
treating orthodontist, so that the orthodontist may ask for
your dental x-rays from your treating dentist.
Payment. Payment refers to the activities
of a group health plan in collecting premiums and paying
claims under the plan for health care services you receive.
Examples of uses and disclosures under this section include
the sending of PHI to an external medical review company to
determine the medical necessity or experimental status of a
treatment; sharing PHI with other insurers to determine
coordination of benefits or settle subrogation claims;
providing PHI to the plan's utilization review ("UR") for
precertification or case management services; providing PHI in
the billing, collection and payment of premiums and fees to
plan vendors such as PPO Networks, UR Companies, Prescription
Drug Card Companies and reinsurance carriers; and sending PHI
to a reinsurance carrier to obtain reimbursement of claims
paid under the plan.
Health Care Operations. Health Care
Operations refers to the basic business functions necessary to
operate a group health plan. Examples of uses and disclosures
under this section include conducting quality assessment
studies to evaluate the plans performance or the performance
of a particular network or vendor; the use of PHI in
determining the cost impact of benefit design changes; the
disclosure of PHI to underwriters for the purpose of
calculating premium rates and providing reinsurance quotes to
the plan; the disclosure of PHI to stop-loss or reinsurance
carriers to obtain claim reimbursements to the plan;
disclosure of PHI to plan consultants who provide legal,
actuarial and auditing services to the plan; and use of PHI in
general data analysis used in the long term management and
planning for the plan and company.
Other Uses and Disclosures Allowed Without
Authorization Federal law also allows a group
health plan to use and disclose PHI, without your consent or
authorization, in the following ways:
- To you, as the covered individual,
- ?To a personal representative designated by you to
receive PHI or a personal representative designated by law
such as the parent or legal guardian of child, or the
surviving family members or representative of the estate of
a deceased individual.
- To the Secretary of Health and Human Services (HHS) or
any employee of HHS as part of an investigation to determine
our compliance with the HIPAA Privacy Rules.
- To a Business Associate as part of a contracted
agreement to perform services for the group health plan.
- To a health oversight agency, such as the Department of
Labor (DOL), the Internal Revenue Service (IRS) and the
Insurance Commissioner's Office, to respond to inquiries or
investigations of the plan, requests to audit the plan, or
to obtain necessary licenses.
- To public health officials to prevent public health
risks, including (a) to prevent or control disease, injury
or disability; (b) to report births and deaths; (c) to
report child abuse or neglect; (d) to report reactions to
medications or problems with products; (e) to notify people
of recalls of products they may be using; (f) to notify a
person who may have been exposed to a disease or may be at
risk for contracting or spreading a disease or condition;
and (g) to notify the appropriate government authority if we
believe you have been the victim of abuse, neglect or
domestic violence.
- To military authorities, as required, if you are a
member or veteran of the armed forces.
- To authorized federal officials for intelligence,
counterintelligence and national security activities
authorized by law, or to conduct special investigations and
provide protection to the President of the United States.
- In response to a court order, subpoena, discovery
request or other lawful judicial or administrative
proceeding.
- As required for law enforcement purposes. For example to
notify authorities of a criminal act.
- As required to comply with Workers' Compensation or
other similar programs established by law.
- To the Plan Sponsor, as necessary to carry out
administrative functions of the plan such as evaluating
renewal quotes for reinsurance of the plan, funding check
registers, reviewing claim appeals, approving subrogation
settlements and evaluating the performance of the plan.
- In providing you with information about treatment
alternatives and health services that may be of interest to
you as a result of a specific condition that the plan is
case managing. The examples of permitted uses and
disclosures listed above are not provided as an all
inclusive list of the ways in which PHI may be used. They
are provided to describe in general the types of uses and
disclosures that may be made.
OTHER USES AND DISCLOSURES
Other uses and disclosures of your PHI will only be made
upon receiving your written authorization. You may revoke an
authorization at any time by providing written notice to us
that you wish to revoke an authorization. We will honor a
request to revoke as of the day it is received and to the
extent that we have not already used or disclosed your PHI in
good faith with the authorization. You understand that we are
unable to take back any disclosures we have already made with
your permission, and that we are required to retain our
records of the benefits provided to you through the C-P
Flexible Packaging, Inc. Employee Benefit Plan.
YOUR RIGHTS IN RELATION TO PROTECTED HEALTH
INFORMATION
Right to Request Restrictions on Uses and
Disclosures You have the right to request that the
plan limit its uses and disclosures of PHI in relation to
treatment, payment and health care operations or not use or
disclose your PHI for these reasons at all. You also have the
right to request the plan restrict the use or disclosure of
your PHI to family members or personal representatives. Any
such request must be made in writing to the Privacy Contact
listed in this Notice and must state the specific restriction
requested and to whom that restriction would apply.
The plan is not required to agree to a restriction that you
request. However, if it does agree to the requested
restriction, it may not violate that restriction except as
necessary to allow the provision of emergency medical care to
you.
Right to Receive Confidential Communications
You have the right to request that communications
involving PHI be provided to you at an alternative location or
by an alternative means of communication. The plan is required
to accommodate any reasonable request if the normal method of
disclosure would endanger you and that danger is stated in
your request. Any such request must be made in writing to the
Privacy Contact listed in this Notice.
Right to Access to Your Protected Health
Information You have the right to inspect and
copy your PHI that is contained in a designated record set for
as long as the plan maintains the PHI. A designated record set
contains claim information, premium and billing records and
any other records the plan has created in making claim and
coverage decisions relating to you. Federal law does prohibit
you from having access to the following records: psychotherapy
notes; information complied in reasonable anticipation of, or
for use in a civil, criminal or administrative action or
proceeding; and PHI that is subject to a law that prohibits
access to that information. If your request for access is
denied, you may have a right to have that decision reviewed.
Requests for access to your PHI should be directed to the
Privacy Contact listed in this Notice.
Right to Amend Protected Health Information
You have the right to request that PHI in a
designated record set be amended for as long as the plan
maintains the PHI. The plan may deny your request for
amendment if it determines that the PHI was not created by the
plan, is not part of designated record set, is not information
that is available for inspection, or that the PHI is accurate
and complete. If your request for amendment is declined, you
have the right to have a statement of disagreement included
with the PHI and the plan has a right to include a rebuttal to
your statement, a copy of which will be provided to you.
Requests for amendment of your PHI should be directed to the
Privacy Contact listed in this Notice.
Right to Receive an Accounting of Disclosures
You have the right to receive an accounting of
all disclosures of your PHI that the plan has made, if any,
for reasons other than disclosures for treatment, payment and
health care operations, as described above, and disclosures
made to you or your personal representative. Your right to an
accounting of disclosures applies only to PHI created by the
plan after April 14, 2003 and cannot exceed a period of six
years prior to the date of your request. Requests for an
accounting of disclosures of your PHI should be directed to
the Privacy Contact listed in this Notice.
Right to Receive a Paper Copy of this Notice
You have the right to receive a paper copy of
this Notice upon request. This right applies even if you have
previously agreed to accept this Notice electronically.
Requests for a paper copy of this Notice should be directed to
the Privacy Contact listed in this Notice.
COMPLAINTS If you believe your privacy
rights have been violated, you may file a complaint with the
plan or the Secretary of Health and Human Services. Complaints
should be filed in writing with the Privacy Contact listed in
this Notice. The plan will not retaliate against you for
filing a complaint.
PRIVACY CONTACT You may contact the
Privacy Officer for the plan (Nancy Schrum) through your
employer's Human Resources Department at (717) 764-1193.
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