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HIPAA Privacy Policy

FEDERALLY MANDATED NOTICE REGARDING PRIVACY POLICIES AND PRACTICES CONCERNING HEALTH INFORMATION COLLECTED BY PACADVANTAGE ON BEHALF OF EMPLOYERS WHOSE EMPLOYEES ENROLL FOR COVERAGE THROUGH PACADVANTAGE

This Federally Mandated Notice Describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
This notice is issued for use by each employer who enrolls its employees in group medical benefits through Pacific Health Advantage, also known as PacAdvantage, and his or her employees. If you have any questions about this notice please contact your employer or PacAdvantage.

Who is required to comply with the rules stated in this notice?
This notice describes the practices of PacAdvantage, which provides administrative services to employers and employees for group medical benefits by collecting enrollment and premium information for each enrolled employee and forwarding that information to the appropriate health plan. This notice applies only to the extent that any particular employer has not issued a Notice of Privacy Practices under HIPAA, the Health Insurance Portability and Accountability Act. HIPAA requires each employer group health plan to issue to affected employees a notice of privacy practices; this notice fulfills that requirement to the extent your employer has not issued such a notice.

The PacAdvantage pledge to protect your health information
Both PacAdvantage and Federal law recognize that health information about you and your health is personal and private. PacAdvantage is committed to protecting the information about you to which we have access. We create a record of your health plan enrollment (the health plan you have chosen) which, in conjunction with personnel information provided by you and your employer, is forwarded to the health plans, for example, Kaiser, Health Net or Blue Shield, that are responsible for providing your health benefits coverage. This notice applies only to the type of information that we collect. Your personal doctor, his or her medical group, and any clinics, labs, or hospitals where you have received care may have different policies or notices regarding their use and disclosure of your health information. In addition, the health plan you enroll in through PacAdvantage may have its own policies and/or practices concerning your private information.

Federal law requires that we:

• give you this notice of our legal duties and privacy practices concerning your protected health information,
• and that we follow the terms of this notice.

How your protected health information is used: The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures, we will explain what we mean and present some examples. Not every use or disclosure in each category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories described below. In addition, federal law requires, and we commit to, using the minimum information necessary so as to protect your privacy as much as possible.

Employers who enroll their employees in health, dental, vision, or alternative health coverage through PacAdvantage are enrolling their employees in coverage that is fully insured. A fully insured plan is one in which an insurance company or an HMO is responsible to actually provide for your health care or to pay for your health care; PacAdvantage does not provide for or pay for health care. Where your group health benefits are fully insured, the insurance company or HMO, and not PacAdvantage or your employer, is responsible to review and approve payment for the medical care provided by your doctor, etc. Because PacAdvantage and your employer do not actually pay medical claims, the only information your employer, or PacAdvantage on behalf of your employer, needs to collect is information about who you are and your choice of health plan (insurance company). The remainder of this notice describes how we will use this limited information.

For treatment: Treatment is defined by federal regulations. PacAdvantage does not provide direct medical or health care treatment, so PacAdvantage use of health information for treatment would be likely to occur only if you requested our help in obtaining treatment from the health plan in which you are enrolled. We may use or disclose health information about you to facilitate medical treatment or services by providers, although PacAdvantage use of such information is rare.

For payment: Payment is defined by federal regulations. PacAdvantage does not provide direct medical or health care treatment, so PacAdvantage use of health information for payment purposes would be likely to occur only if you requested our help in obtaining payment for medical expenses from the health plan in which you are enrolled. We may use or disclose health information about you to determine eligibility to enroll in coverage through PacAdvantage and to confirm for a health plan whether you are enrolled, thereby obliging that health plan to pay for your health care. However, PacAdvantage use of such information is rare.

For health plan operations: Operations are defined by federal regulations. PacAdvantage does not provide direct medical or health care treatment, so PacAdvantage use of health information for operational purposes would be used only to operate the PacAdvantage program and therefore to operate each employer's group health plan. For example, PacAdvantage may use health information in connection with quality assessment and improvement activities, underwriting analysis, premium rating, or other activities relating to plan coverage issues. We may use health information when seeking legal advice, conducting an audit of any type, using fraud and abuse detection programs, or for business planning such as, but not limited to, cost management and organizational management, or other administration activities. In many circumstances, such as premium analysis, health information used will be the anonymous combined health information of many; that is, information is not identifiable as being about any specific person. In all circumstances, we will use the minimum information necessary so as to protect your privacy as much as possible.

As required by law: We will disclose health information about you when required to do so by applicable law, including governmental agencies and court orders, such as lawful subpoenas, warrants, summonses, or similar judicial or administrative process. Some examples are: we may be required to disclose health information about you during litigation such as your own divorce proceeding or a malpractice suit; we may be asked to disclose information to assist in a criminal investigation, even one concerning you; or we may be asked to release information to assist the government in a civil investigation. If we are asked or compelled to disclose health information about you by someone other than you or your agent, we will comply, but only if efforts have been made to tell you about the request or to obtain an order protecting the information that we have been asked or compelled to disclose.

To avoid a serious threat to health or safety: We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to prevent the threat. For example, we may disclose health information about you in a proceeding regarding the licensure of a physician.

SPECIAL SITUATIONS

Disclosure to health plan sponsor: Information may be disclosed to the plan Administrator of your employer's group medical benefits plan.

Organ & tissue donation: If you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate the donation and/or transplantation.

Military and veterans: If you are a member of the Armed Forces, we may release information about you as required by military command authorities. We may also release health information about foreign military personnel to the appropriate foreign military authority.

Workers compensation: We may release health information about you for workers compensation or similar programs that provide benefits for work-related injuries or illnesses.

Public health risks: We may disclose health information about you for public health activities. These activities generally include the following:

• to prevent or control disease, injury, disability or contagion
• to report births and deaths
• to report child abuse or neglect
• to report reactions to medications or problems with products
• to notify people of recalls of products they may be using
• to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a or condition
• to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or violence. We will only make this disclosure if you agree or when required or authorized by law

Health oversight activities: We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance civil rights laws.

YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU

Right to inspect and copy: You have the right to inspect and copy the health information we have about you. To do this contact PacAdvantage at 877-735-5742. PacAdvantage may charge a fee for the costs of copying, mailing, or other activities or supplies associated with your request.

We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health information, you may request in writing that the denial be reviewed.

Right to amend: If you feel the health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for your employer's group medical benefits program. To request an amendment, your request must be made in writing and submitted to PacAdvantage. In addition, you must provide a reason that supports your request.

We may deny your request for an amendment if it is not in writing or does not include an appropriate reason to support the request. In addition, we may deny your request if you ask us to amend information that:

• is not part of the information kept by or for the plan; in other words, it is information kept by some other person or entity
• was not created or collected by us, unless the person or entity that created the information is no longer available to make the amendment
• is not part of the information which you would be permitted to inspect and copy
• is already accurate and complete

Right to an accounting of disclosures: An accounting of disclosures is a list of the persons to whom your plan has disclosed your protected health information in a specified time frame. You have the right to request an "accounting of disclosures" where such disclosure was made for any purpose other than treatment, payment, or health care operations.

To request this list of disclosures, you must submit your request in writing to PacAdvantage. Your request must state a time period that may not be longer than six years in duration, and must not include dates before April 2003. Your request should indicate in what form you want the list (for example, paper or electronic). The first list you request within a l2-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred

Right to request restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. However, since PacAdvantage does not collect any information about specific conditions or treatments, this type of restriction is unlikely to be necessary. We are not required to agree to your request.

To request restrictions, must make your request in writing to PacAdvantage. In your request, you must tell us:

• what information you want to limit
• whether you want to limit our use, disclosure or both
• to whom you want the limits to apply, for example, disclosures to your spouse.

Right to request confidential communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.

To request confidential communications, you must make your request in writing to PacAdvantage. We will not ask the reason for your request. We will accommodate all reasonable requests, but we decide what is reasonable and what is not. Your request must specify how you wish to be contacted and must provide accurate contact information.

Right to a paper copy of this notice: You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, or if we are entitled by law to send it to you electronically, you are still entitled to a paper copy of this notice.

You may obtain a copy of this notice at http://www.pacadvantage.org/hipaa_policy.asp or by calling PacAdvantage at 877-735-5742.

CHANGES TO THIS NOTICE

We reserve the right to change this notice at any time. We reserve the right to make the revised or changed notice effective for health information we have about you at the time the change is made, as well as effective for health information obtained in the future. We will post a copy of this current notice on each plan's web site. The effective date is April 14, 2003

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with the offending entity or the U.S. Secretary of Health and Human Services. To file a complaint with PacAdvantage, call PacAdvantage. To file a complaint with your employer, contact your employer. All complaints should be submitted in writing. Privacy Officer for PacAdvantage will handle review of your complaint. You will not be penalized by filing a complaint. Your right to file a complaint is not any type of guarantee of enrollment through PacAdvantage.