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HEALTH PLAN
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.
We respect the confidentiality of your health information and
will protect it in a responsible and professional manner. The
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
requires us to protect the privacy of Protected Health Information
(Your Information) and to send you this notice.
This notice applies to the Health Plans provided by the
Affiliated Covered Entity defined below. It describes how we may
use and share Your Information to carry out payment and health care
operations. And, it describes how we may use and share Your
Information for other purposes that are permitted or required by
law. In the event uses or disclosures of Your Information described
in this notice are prohibited or materially limited by other
applicable law in your state we will comply with that more
stringent law.
We abide by the terms of this notice. If we materially change
the terms of this notice we will mail you a copy of the revised
notice if you are then covered by one of our Health Plans. Copies
of our current notice may be obtained by contacting us at the
telephone number or address below, or may be found on our Web site
at www.bankerslife.com.
It is not necessary for you to take any action as a result of
this notice unless you wish to exercise one or more of your rights
as explained under the Rights That You Have
section.
HOW WE USE OR SHARE
YOUR INFORMATION
The following are different ways that we use and share Your
Information:
Your Authorization
Except as described below, we will not use or share Your
Information unless you have signed a form telling us we can. You
may revoke your authorization, in writing, but not for any
information that we have already relied on. Nor may you revoke your
authorization if signing it was a condition of obtaining insurance
and we have the right, under other law, to contest a claim under
the policy.
Use and Share for Payment
We may request, use, and share Your Information as necessary to
help pay your medical bills that have been submitted to us. As one
example, we may use information regarding your medical procedures
and treatment to process and pay claims.
Use and Share for Health Care
Operations
We may use and share Your Information with others who help us
conduct our business operations. Examples of business operations
might be, underwriting your policy, reinsurance, compliance,
auditing, and other functions related to your Health Plan. We will
not share Your Information with outside groups unless they agree to
keep it protected.
Family and Friends Involved in Your
Care
We may share Your Information with your family, friends, and
others who are involved in your care or payment of a claim unless
you can and do object. If we determine that a limited disclosure is
in your best interest, we may share Your Information with such
individuals, even if you are incapacitated or not available. For
example, we may use our professional judgment to disclose
information to your spouse concerning the processing of a claim. If
you do not wish us to share Your Information with your spouse or
others, you may exercise your right to request a restriction on our
disclosures of Your Information (see below).
Other Products and Services
We may contact you to provide information about other
health-related products and services that may be of interest to
you. For example, we may contact you about our health insurance
products that could enhance or substitute for existing Health Plan
coverage, and about health-related products and services that may
add value to your Health Plan.
Other Uses and Disclosures -
Unless otherwise prohibited by law, we may, under certain
circumstances, as described below make other uses and disclosures
of Your Information without your authorization.
- We may use or disclose Your Information for any purpose
required by law. For example, to respond to a court order.
- We may disclose Your Information for public health activities,
such as reporting of disease, injury, birth and death, and for
public health investigations.
- We may disclose Your Information to the proper authorities if
we suspect child abuse or neglect; we may also disclose Your
Information if we believe you to be a victim of abuse, neglect, or
domestic violence.
- We may disclose Your Information if authorized by law to a
government oversight agency (e.g., a state insurance department)
conducting investigations, or civil or criminal proceedings.
- We may disclose Your Information in the course of a judicial or
administrative proceeding (e.g., to respond to a subpoena or
discovery request).
- We may disclose Your Information to the proper authorities for
law enforcement purposes.
- We may disclose Your Information to coroners, medical
examiners, and/or funeral directors consistent with law.
- We may use or disclose Your Information for cadaveric organ,
eye or tissue donation.
- We may use or disclose Your Information for research purposes,
but only as permitted by law.
- We may use or disclose Your Information to avert a serious
threat to health or safety.
- We may use or disclose Your Information if you are a member of
the military as required by armed forces services, and we may also
disclose Your Information for other specialized government
functions such as national security or intelligence
activities.
- We may disclose Your Information to workers' compensation
agencies for your workers' compensation benefit determination.
- We will, if required by law, release Your Information to the
Secretary of the Department of Health and Human Services for
enforcement of HIPAA.
RIGHTS THAT YOU
HAVE
Access to Your Information
You have the right to inspect and obtain a copy of certain
information that we maintain about you in your Designated Record
Set. Your request must be in writing and signed by you. We may
charge you a fee for copying and postage. You may request access
request forms from us at the address below.
Amendments to Your Information
You have the right to request that Your Information be amended or
corrected. We will give each request careful consideration but we
are not required to amend Your Information. Your amendment request
must be in writing, must be signed by you, and must state the
reasons for the request. You may ask for amendment request forms
from us at the address below.
Accounting for Disclosures of Your
Information
You have the right to receive an accounting of certain disclosures
of Your Information made by us during the six years prior to your
request. Please note that we are not required to provide you with
an accounting of the following information:
- Any information collected prior to April 14, 2003;
- Information disclosed or used for treatment, payment, and
health care operations purposes;
- Information disclosed to you or pursuant to your
authorization;
- Information that is incident to a use or disclosure otherwise
permitted;
- Information disclosed for a facility's directory or to persons
involved in your care or other notification purposes;
- Information disclosed for national security or intelligence
purposes;
- Information disclosed to correctional institutions, law
enforcement officials or health oversight agencies;
- Information that was disclosed or used as part of a limited
data set for research, public health, or health care operations
purposes.
To be considered, your accounting requests must be in writing
and signed by you. You may ask for accounting request forms from us
at the address below. The first accounting in any 12-month period
is free; however, we may charge you a fee for each subsequent
accounting you request within the same 12-month period.
Restrictions on Use and Disclosure of Your
Information
You have the right to ask us to restrict how we use or disclose
Your Information for insurance payment or health care operations
purposes, or to family members and others who are involved in your
health care or payment for your health care. We are not required to
agree to your request but will attempt to honor reasonable
requests.
We retain the right to terminate an agreed-to restriction if we
believe it is appropriate. If we terminate the restriction we will
notify you of such termination. You also have the right to
terminate, in writing, any agreed-to restriction. You may request a
restriction (or termination of an existing restriction) by
contacting us at the address below.
Request for Confidential
Communications
You have the right to ask to receive confidential communications
regarding Your Information. For example, if you think that you
would be harmed if we left you a message on voice mail or sent
information to a particular address, you can ask us to send the
information by alternate means such as by fax or to an alternate
address. Requests for confidential communications must be in
writing, signed by you, and sent to us at the address below.
Right to a Paper Copy of the
Notice
You have the right to a paper copy of this notice upon request by
contacting us at the telephone number or address below.
Complaints
If you believe your privacy rights have been violated, you can
file a complaint with us in writing at the address below. You may
also file a complaint in writing with the Secretary of the U.S.
Department of Health and Human Services in Washington, D.C., within
180 days of a violation of your rights. Filing a complaint will not
negatively impact your status as an insured or the services you
receive from us.
Personal Representative
We will treat your personal representative as you, except where
prohibited by law.
DEFINITIONS
Affiliated Covered Entity (ACE) means,
for purposes of this Notice, the Health Plans issued by certain
companies that are under common ownership1.
Designated Record Set means the
information maintained and used by us to make decisions about
you.
Health Plan means, for purposes of
this Notice, the following health related products: major medical,
basic medical, long term care, short-term care, Medicare
supplement, vision, dental, specified disease (e.g., cancer),
hospital indemnity, intensive care, and other coverages that meet
the definition of Health Plan contained in HIPAA. The following
products are not considered Health Plans: coverage only for
accident, or disability income insurance, or any combination
thereof, life insurance, annuities and other coverages that do not
meet the definition of Health Plan contained in HIPAA.
Protected Health Information (Your
Information) means information about you that we have collected and
maintain and that identifies you, or reasonably could identify you,
and that relates to:
- your past, present, or future physical or mental health or
condition;
- the provision of health care to you; or
- the past, present, or future payment for the provision of
health care to you.
Protected Health Information includes that of persons living or
dead.
FOR FURTHER INFORMATION
If you have questions or need further assistance regarding this
Notice, you may contact our Privacy Office by writing to:
Bankers Life and Casualty Company
Privacy Office
600 West Chicago Ave
Chicago, Illinois 60654-2800
Telephone: 1-866-385-7252
EFFECTIVE DATE
This Notice is effective April 14, 2003.
1Affiliated Covered Entity:
Bankers Life and Casualty Company, Bankers Conseco Life Insurance
Company, Colonial Penn Life Insurance Company, Conseco Insurance
Company, Conseco Health Insurance Company, Conseco Life Insurance
Company, Washington National Insurance Company
Policyholders click
here for questions and answers about the Notice of Privacy Practices and HIPAA.
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